Re: Rafina Hosein
ORB File No: 7877
Hearing held on: Monday, January 13, 2025
Place of hearing: Ontario Shores Centre for Mental Health Sciences
Pursuant to: Section 672.81(1) of the Criminal Code
Before:
Alternate Chairperson: Mr. C. MacIntyre, K.C. Members: Dr. K. Patel Dr. W. Loza Ms. C. Murray Mr. S. Duffy
Parties Appearing:
Accused: Rafina Hosein Counsel: Mr. T.R. McIver
The person in charge of hospital: Representative: Dr. M. Pearce
Attorney General of Ontario: Counsel: Ms. N. MacDonald
REASONS FOR DISPOSITION
(Dated February 24, 2025)
Introduction
On April 15, 2021, Rafina Hosein was found not criminally responsible on account of mental disorder on charges of criminal harassment (x2), fail to comply release order (x2) and fail to comply recognizance, all contrary to the Criminal Code.
Ms. Hosein is currently subject to an Ontario Review Board disposition of February 1, 2024, which ordered her detained within the Forensic Program at Ontario Shores Centre for Mental Health Sciences with privileges up to and including to live in the community in accommodation approved by the person in charge.
On January 13, 2025, the Ontario Review Board convened at Ontario Shores Centre for Mental Health Sciences (“Ontario Shores”) to conduct Ms. Hosein’s annual review and to make a disposition further to s. 672.81(1) of the Criminal Code.
At the outset of the hearing, the parties were canvassed as to their positions. All parties agreed that Ms. Hosein remained a significant threat to the safety of the public and that there be no change in her disposition.
Index Offences
- The index offences are outlined in last year’s Reasons for Disposition as follows:
"Criminal Harassment x2
On November 9, 2018, the victim, the accused’s daughter Shivone, threw a birthday and did not invite the accused. This was in part due to her mother’s mental health problems and the difficulties she would create at the party. Ms. Hosein felt slighted and began a pattern of stalking and harassing the victim. Each day from November 9, 2018 to December 11, 2018 Ms. Hosein called the victim dozens of times leaving angry, rambling voicemails. On occasion, the victim would answer the call to tell the accused to stop calling. This had no effect.
Ms. Hosein would frequently attend the victim’s apartment and bang on the door. On December 5th, 7th and 10th, 2018, the accused pulled the fire alarm.
Fail to Comply x3
On January 20, 2020, Ms. Hosein attended the victim’s residence at approximately 5:00 a.m. and proceeded to bang on the door. The police were called and she was arrested for fail to comply with a court order to stay away from the victim’s residence.
On May 9, 2020, Ms. Hosein again attended this building, banging on the victim’s door. She was arrested for this breach of a court order.
On May 12, 2020, Ms. Hosein was in the lobby of the victim’s apartment building breaching a term to not attend at this building.”
Background
A hospital report of December 23, 2024, was filed as an exhibit to this hearing. It contains a description of Ms. Hosein’s personal, criminal, and psychiatric background and should be referred to for detail.
Ms. Hosein is almost 61 years old. She hails from Trinidad and was 22 years old when her father arranged her marriage. In 1988 she travelled to Toronto while pregnant with her second child, Shivone. She did not return to Trinidad and she and her husband eventually separated.
Eventually, Ms. Hosein entered a relationship with another man lasting for 18 years. They bore another daughter, Sabrina. According to Shivone, it is at this time that her mother’s mental health issues were observed. She began gambling and drinking excessively and would become verbally abusive. The girls were left alone. Children's Aid removed the girls from Ms. Hosein’s care. Eventually, Shivone took over custody of her eight-year-old younger sister when she was 16 years of age.
Much of the accused’s background while in Canada comes from her daughter, Shivone. For about a four-year period Ms. Hosein received treatment and medication through CAMH but after a year of progress the accused stopped taking her medication and began drinking and gambling again.
As described above regarding the circumstances of the index offence, the accused’s daughter, Shivone, and her younger sister lived in a state of anxiety and fear due to her mother’s actions over the years.
A criminal responsibility assessment report prepared by Dr. Harrigan on February 26, 2021, recites:
“Ms. Hosein had a well-established diagnosis of Schizoaffective Disorder, Bipolar Type. Ms. Hosein also had a history of non-compliance with antipsychotic medications, as well as mood stabilizing medications. She typically deteriorated rapidly in the context of medication noncompliance, and it would take a relatively long period of time to re-stabilize her. When unwell, she exhibited paranoid and grandiose delusions. Her thinking would become disorganized, and she would become verbally aggressive and difficult to engage. Her verbal aggression, and threats of serious physical aggression, resulted in her needing to be placed into seclusion for varying amounts of time during inpatient psychiatric admissions. She had a number of lengthy admissions to various psychiatric hospitals, such as CAMH, Ontario Shores, Michael Garron Hospital, and St. Joseph’s Hospital. Many of these admissions were on an involuntary basis. Historically, Ms. Hosein was found incapable to consent to treatment, and the Public Guardian and Trustee has acted as her Substitute Decision Maker.”
Although Ms. Hosein has no prior criminal convictions registered against her, she had been charged numerous times with harassment and uttering threats and failure to comply, all of which were either withdrawn or stayed. Most of these charges related to harassment against her daughter Shivone and involved Shivone’s two daughters.
Another victim, Alan Louthe, was also subject to threats and harassment and a number of charges involved these actions by the accused.
Following the index offences, Ms. Hosein was deemed unfit to stand trial until finally, on November 23, 2020, she was found fit. She was diagnosed with schizoaffective disorder and was found incapable with respect to treatment decisions for this. The Public Guardian and Trustee became her substitute decision maker.
Eventually, Ms. Hosein was transferred to the hospital’s rehabilitation unit. Gradual steps to discharge her to the community took place and on September 25, 2023, she was discharged to an independent living apartment in Toronto, 1908 Gerrard Street East, where she resides to this date.
Ms. Hosein’s current diagnoses are schizoaffective disorder, bipolar type, alcohol use disorder, in remission and cluster B personality traits.
Evidence
Dr. Pearce continues to be Ms. Hosein’s attending psychiatrist and Dr. Pearce authored the December 23, 2024, hospital report and he endorsed its contents in his evidence today.
Ms. Hosein remains incapable of consenting to treatment and the Public Guardian and Trustee is her substitute decision maker.
Ms. Hosein continues to live independently in her subsidized apartment at Gerrard Street East in Toronto, an area still considered to be part of the catchment area of Ontario Shores. Ms. Hosein has consistently claimed that she does not have a mental illness and does not need medication. She has periodically complained of chest pain associated with medication including Invega Sustenna. On February 26, 2024, Ms. Hosein’s medication was switched from Invega Sustenna every 35 days to Invega Trinza, every 90 days.
Although she was compliant with her medication and from time-to-time was pleasant and well engaged, at other times she became verbally abusive and irritable with staff. By the summer of 2024 she became more obsessed about contacting her daughters who are the subject of a no contact provision in her disposition.
In May of 2024, the hospital team reached out to her daughter Shivone, however, no response was received. Ms. Hosein then became increasingly irritable and uncooperative. She began leaving Dr. Pearce, her psychiatrist, dozens of voicemails per month and dozens of emails. She asked inappropriate questions of him, buying him gifts and presenting him with homemade food. By September of 2024, her conduct became increasingly inappropriate towards her psychiatrist and erotomanic delusions were present. At this point, her medication was switched back to the monthly Invega Sustenna.
Dr. Pearce suggests that if she had more structure to her time and involved herself more in activities such as schooling this might move her away from this behaviour.
The hospital report notes that Ms. Hosein’s inappropriate communication continued into early December 2024, however, Dr. Pearce testified today that in the past few months her behaviour has become more settled. Ms. Hosein continues to cooperate with her monthly injection although she does not necessarily agree with it. Dr. Pearce’s goal is to increase Ms. Hosein’s insight although he is not optimistic that this will change much.
Her communication with her family is a difficult area for her. She seems to be abiding by the term in her disposition not to contact them. Dr. Pearce testified that her current monthly injection seems to work well, however, he is of the opinion that the level of symptoms that she now has are about as good as it is going to get.
Dr. Pearce was asked why the gambling disorder has been removed from Ms. Hosein’s current diagnosis. Dr. Pearce testified that gambling has not been observed during her stay in hospital.
In responding to questions about Ms. Hosein's history of alcohol use, Dr. Pearce suggested that perhaps there is no need for a substance prohibition in Ms. Hosein’s disposition. He agrees that alcohol is a disinhibitor and he acknowledges Ms. Hosein’s history of alcohol use which caused her to be verbally abusive and leaving her daughters alone at night in the past.
Dr. Pearce believes that Ms. Hosein has taken a substance use program some years ago, but he will take this up with her again and consider if treatment can be renewed if necessary.
The hospital report outlines the clinical assessment of Ms. Hosein’s risk which:
“... are identified by the HCR-20 and most notably include a major mental illness with breakthrough symptoms, poor insight into same, an historical substance use disorder and maladaptive personality attributes.
Absent a disposition of the ORB, she would immediately discontinue her long-acting medication and deteriorate. In those circumstances she is at high risk of causing serious physical or more likely, psychological harm to members of the public”.
- In their submissions, all parties agreed jointly that Ms. Hosein remained a significant threat to the safety of the public and that her disposition continue without change. The hospital and Crown Attorney both indicated their wish to have the prohibition on substances remain in Ms. Hosein’s disposition. Mr. McIver, although not arguing removal of the alcohol prohibition clause, does submit that given the evidence, alcohol is no longer an issue.
Decision
The Board agrees with the joint submissions of the parties that Ms. Hosein remains a significant threat to the safety of the public and that her disposition order continue without change. Dr. Pearce has testified that until Ms. Hosein’s medication change and the consequences of that change over the last year, she had been heading in the right direction towards a conditional discharge. She seems to be stabilized now, however, a number of symptoms remain. It is Dr. Pearce’s hope that Ms. Hosein’s insight will improve and one of the goals is to encourage her to engage in structured recreation activities and increase her social support network. She is now motivated to find employment.
The Board takes note of the summary and risk management plan comments outlined in the hospital report that:
“Overall, in the context of a Conditional Discharge from the ORB, Ms. Hosein’s risk for violence is considered to be Moderate. In terms of risk management recommendations, considering her status in independent housing, lack of insight, and guarded demeanour, it may be possible for changes in Ms. Hosein’s mental status to go undetected or difficult to gauge in intensity, until significant decompensation or disinhibition is evident. As such, a conservative approach is therefore recommended in reducing supervision and visits in the community. Should Ms. Hosein decline medication, the safest approach would likely be to consider prompt re-admission to hospital, considering her history of declining quickly when medication non-adherent.”
- In all the circumstances, the Review Board is of the opinion that the necessary and appropriate disposition is a continuation of her current disposition order without change.
DATED this 24th day of February, 2025, at the City of Toronto, in the Toronto Region.
Mr. C. MacIntyre, K.C. Alternate Chairperson