Re: Haitham Abed
ORB File No: 8145
Hearing held on: Monday, January 13, 2025
Place of hearing: Ontario Shores Centre for Mental Health Sciences 700 Gordon Street, Whitby
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: Haitham Abed Counsel: Ms. E. Holder
The person in charge of hospital: Counsel: Ms. A. Marshall
Attorney General of Ontario: Counsel: Ms. N. MacDonald
REASONS FOR DISPOSITION
(Dated February 24, 2025)
Introduction
On June 15, 2022, Haitham Abed was found not criminally responsible on account of mental disorder on charges of mischief – not exceeding $5000, assaulting peace officer with weapon/causing bodily harm, assault with a weapon, and killing or injuring animals other than cattle, all contrary to the Criminal Code.
Mr. Abed is currently subject to an Ontario Review Board disposition of January 17, 2024, which ordered him detained within the Forensic Program of 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 Mr. Abed's annual review and to make a disposition further to s. 672.81(1) of the Criminal Code. An Arabic interpreter was available; however, Mr. Abed was able to participate with minimal assistance from him.
The parties were invited to present their preliminary positions. The hospital recommended a conditional discharge for Mr. Abed with an allowance for travel passes to Iraq for up to a month with an itinerary approved by the person in charge or designate. The Crown supports this. On behalf of her client, Ms. Holder indicated that Mr. Abed is seeking an absolute discharge.
At the conclusion of the evidence and submissions, the Board ordered that Mr. Abed be discharged conditionally with the conditions as proposed by the hospital, but for modified wording regarding the travel pass.
Index Offences
- Last year’s Reasons for Disposition provides a summary of the index offences as taken from the hospital report presented at the hearing.
"Mr. Abed rented a room at 427 Dufferin Avenue in London, Ontario. On August 27, 2021 at approximately 0800 hours, Mr. Abed was observed by his roommate throwing garbage around outside. The roommate requested Mr. Abed to stop, and Mr. Abed refused and shouted obscenities at her. Mr. Abed’s roommate exited the residence in fear of Mr. Abed. She spoke to a neighbour and decided to call police for help.
While waiting for the police to arrive, Mr. Abed exited the residence while he was carrying a knife. He set the knife down and started to dismantle the front porch by ripping up several wooden floorboards. He also emptied the contents of several garbage bins and threw old car tires onto the front lawn, driveway, and street.
A neighbour attempted to intervene and asked Mr. Abed to stop. Words were exchanged, and Mr. Abed tore off the front railing and threw it at the neighbour, and nearly struck him. Another neighbour attempted to intervene and was assaulted by Mr. Abed. Community member came forward and observed the incident. The individual who was assaulted wished to remain anonymous.
Prior to police arrival, Mr. Abed paced around the area, carrying a baluster (wooden spindle) in each hand while waving it around. As community members walked into the area, Mr. Abed became fixated towards them; he walked towards them while holding the balusters in his hands.
As vehicles drove down the street, Mr. Abed walked on the roadway towards the vehicles holding the balusters in his hands.
Multiple officers responded into the area. Canine Officer M. Tountas and Police Service Dog Max were first to arrive and attempted to deescalate Mr. Abed and asked him to stop. Mr. Abed refused to follow Officer Tountas commands and advanced toward him and the police service dog with balusters in hand. Mr. Abed struck the police service dog in the head and body. In order to protect the police service dog and take control of Mr. Abed, Officer Tountas attempted to take physical control of Mr. Abed. Mr. Abed then struck Officer Tountas with the baluster once on his left forearm and once on his left wrist.
Multiple officers arrived on the scene. At this juncture, Mr. Abed walked past a parked police cruiser and struck it with a baluster causing some damage. Subsequently, a conducted energy weapon was deployed against Mr. Abed. He was arrested and taken into custody. After the arrest, Mr. Abed was transported to Victoria Hospital to be medically cleared and was cleared the same morning.
Mr. Abed was transported and accepted into the cells by a sergeant. When Mr. Abed was taken to the fingerprint room he was advised by a cadet he would be removing his mask to obtain a photo. At this point, Mr. Abed spat in the direction of Cadet Worby; sputum striking him on the left arm.
The total damage sustained was $4050. The police service dog Max sustained soft tissue damage to the left shoulder and forearm and a cut to his gumline. Officer Tountas sustained soreness and abrasions to his left wrist and forearm.”
Background
The hospital report of December 12, 2024, was filed as Exhibit 1 to this hearing. It contains information regarding Mr. Abed’s personal, psychiatric, and criminal background and should be referred to for detail.
Mr. Abed is a 36-year-old-man who was born in Iraq. He immigrated to Canada when he was either 15 or 22 years of age – the exact date is uncertain. Mr. Abed has reported he attended school for English as a second language from 2010 to 2013.
Mr. Abed reports that he worked in the food service industry until he injured a finger in 2014 while working as a butcher. That injury resulted in his loss of employment and, according to him, was coincident with the onset of his mental health difficulties. Thereafter, with the benefit of antipsychotic medication he was able to work at various labour-type endeavours but never on a full-time basis due to the sedating effects of the medications.
Following the index offences Mr. Abed was diagnosed with schizophrenia and that is the diagnosis today.
Mr. Abed’s only criminal conviction appears to be for mischief over $5,000 in August of 2019. He received a conditional discharge and probation of 12 months. Other charges of arson and mischief under $5,000 were withdrawn.
There is no history given by Mr. Abed of using alcohol or illicit substances and he denies the use of same. Notwithstanding this, a discharge diagnosis from the North York General Hospital in December of 2019 included schizophrenia, cannabis use disorder, and substance induced psychosis. There is no other reference to a high use of substances.
A review of Mr. Abed’s medical records prior to the index offences indicates that he was involuntarily admitted to hospital for psychiatric assessment five times prior to the index offences. From at least 2015, he had been seeing a Dr. Bhzadi, a community psychiatrist in Scarborough, who provided him with antipsychotic medication with which he was not always compliant.
Following Mr. Abed’s admission to hospital after the index offence he was restarted on intramuscular Invega Sustenna medication, and he continued to live in the community in an independent apartment and continued to work.
Mr. Abed continues to have a close relationship with his family who live in Iraq.
At last year’s annual review, Mr. Abed continued to do well and had been compliant with his medication and engagement with his treatment team. His insight into the benefit of medication was good.
Mr. Abed had expressed concern about side effects from his long-acting injectable of Invega, specifically sexual dysfunction. He agreed to take an oral medication, Abilify, to help with this and this resulted in some improvement though continued to be a concern of his. An alternative antipsychotic medication has been considered by Mr. Abed and the hospital to potentially cope better with the side effects.
Mr. Abed is consistently in contact with his family in Iraq. A privilege in his disposition order providing travel passes to Iraq for up to one month, reflects his wish to visit his family.
Evidence at Hearing
Dr. Darmant Bhullar has been Mr. Abed’s outpatient psychiatrist for approximately two years. She is the author of the current hospital report of December 12, 2024, and an addendum of January 9, 2025; these documents were filed as Exhibits 1 and 2 respectively.
The December 12, 2024, hospital report includes a recommendation by the hospital for an absolute discharge for Mr. Abed. The January 9, 2025, addendum to the hospital report retracts that recommendation and instead recommends a conditional discharge. The evidence in support of the hospital’s change is provided in the addendum to the hospital report and by Dr. Bhullar’s viva voce evidence at today’s hearing.
Mr. Abed has continued to live in an independent apartment in the community and has been engaged with and has communicated well with his treatment team. He has been compliant with taking his long-acting injectable medication Invega and has appreciated the benefits from it.
For some time, Mr. Abed believed that a side effect of this medication was his inability to fully ejaculate. To combat or neutralize this side effect he was agreeable to taking an oral medication, Abilify. This somewhat improved his ability to ejaculate.
Mr. Abed was advised that there is no relationship between the use of Invega and sexual dysfunction and that it was more likely related to psychological stressors. Mr. Abed spent a month at home in Iraq and while there he did not experience any sexual dysfunctions. As a result, Mr. Abed was content to continue with Invega. Given Mr. Abed’s interest to move to Iraq for a longer period of time or even live there, the hospital determined that Invega Sustenna is also available in Iraq should he choose to move there.
With his normal sexual response while in Iraq and information that his sexual dysfunction is unrelated to the medication he was taking, Mr. Abed was content to remain on Invega. Due to Mr. Abed’s commitment to medication and the improvements generally in his mental health and rehabilitation, the hospital concluded that an absolute discharge was appropriate and indicated this in the Dec. 12 hospital report.
About a week before the hearing, Mr. Abed advised Dr. Bhullar that he was now unable to perform sex as he liked and he had asked his community psychiatrist, Dr. Wang, to change his medication to long acting Abilify.
With this new information, Dr. Bhullar composed the Addendum to the hospital report of January 9, 2025 which changes the hospital’s recommendation from an absolute discharge to a conditional discharge.
The principle reason for the hospital’s change in recommendation is that Mr. Abed has a long history of not always being compliant with his medication and, significantly, he decompensates quickly when noncompliant. This change in his confidence about Invega, and wish to stop it illustrates the risk of discharging him absolutely.
As outlined by Dr. Bhullar in the addendum to the hospital report:
“Mr. Abed has never been treated with Abilify Maintenna, and its effectiveness in managing his psychotic symptoms remain uncertain. Medication changes carry a risk of decompensation and historically Mr. Abed has rapidly decompensated without medication, leading to aggressive behaviour requiring police intervention. At this time, it is the unanimous opinion of the treatment team that Mr. Abed remains a significant threat to the safety of the public, as per Winko.”
When Mr. Abed learned that the treatment team was no longer recommending an absolute discharge, he then expressed his willingness to continue with Invega. It was obvious to Dr. Bhullar that this change in his position was so that he could achieve an absolute discharge. This is another reason why the hospital takes the position that Mr. Abed is a significant threat to the safety of the public, as it is an indication of his conviction that prescribed antipsychotic medication is causing his sexual dysfunction despite medical advice to the contrary and despite normal sexual functioning for the entire time that he was in Iraq while taking Invega.
It is a major concern of Dr. Bhullar’s that he would not stay on his medication if absolutely discharged.
The hospital’s plan is that while Mr. Abed is under the Review Board’s jurisdiction and on a conditional discharge disposition, a change from Invega to Abilify could take place in a controlled manner. If a change to Abilify results in a deterioration of his mental state, either during the transition from one medication to the other or whether it is ineffective in treating Mr. Abed’s illness, that risk can be managed under a conditional discharge and the Mental Health Act would be adequate to respond to any deterioration of his mental state.
As the hospital has already confirmed that Invega Sustenna is available in Iraq it would have to determine if Abilify is available there too. If Mr. Abed is absolutely discharged, he could arrange for a community psychiatrist to make the change from Invega to Abilify; however, Dr. Bhullar points out that if Mr. Abed was under a Board disposition it would require him to meet regularly with them, but he has no obligation to do that under an absolute discharge. Furthermore, while a transition is taking place to a new medication the hospital’s team can provide more complete and full oversight that is not available in a civil setting.
Additionally, and of importance, is that the hospital team is very familiar with Mr. Abed and his history over many years. A gap in familiarity and treatment history is illustrated when Mr. Abed asked his community psychiatrist, Dr. Wang, to change his medication. Dr. Wang assumed that Mr. Abed’s sexual dysfunction was due to Invega as Mr. Abed told him that. But Dr. Wang did not know of the lack of evidence of this connection by the opinion provided by the hospital to Mr. Abed and by his normal sexual functioning during his trip to Iraq, each of which supported that there was no connection between Invega and Mr. Abed’s sexual dysfunction.
Dr. Bhullar acknowledges that Mr. Abed has good insight into his illness, and he recognizes the symptoms of his mental disorder and that he would also return to hospital if asked. Mr. Abed has said that the reason that he is so sure that Invega is the problem is because his sexual dysfunction began after he began that medication.
Mr. Abed saw a urologist in 2020 for his sexual dysfunction. He is open now to have further medical exploration to find other reasons for his sexual dysfunction, but this would take a great deal of time to make a referral and to complete. The change to Abilify now would appear to be the faster route to potentially satisfy Mr. Abed. Dr. Bhullar expects that if a controlled change to Abilify is made now, the hospital team would know the results of that by early May of this year. What is less certain is that even if the Abilify medication successfully controls his psychotic symptoms, will it improve his sexual dysfunction or Mr. Abed’s perception of the cause of his dysfunction. Mr. Abed has indicated that if Abilify is not effective he would be open to returning to Invega Sustenna.
Dr. Bhullar was questioned about Mr. Abed’s cannabis use. She does not consider cannabis use to be an active risk at this time. When Mr. Abed returned from his Iraq trip in April of 2024, his employer had replaced him, and he was without a job. He later found work in the summer and has continued to work three to five days per week with a construction company and occasional shifts at a local shisha bar.
Until he found work after his return from Iraq, Mr. Abed told his treatment team that he began to perceive that the number 14 kept surfacing everywhere. This distressed him. He became concerned that someone may kill him because he shared the same birthdate as the Iranian president. He also advised that he had used cannabis earlier in the day and asked to be admitted to Ontario Shores until he felt safer. These symptoms were similar to those that he experienced at the time of the index offence,
Also at this time, Mr. Abed admitted that while a cousin stayed with him for a few days they consumed more cannabis than he usually would. He expressed that his financial stressors, boredom, and increased cannabis consumption were factors in his minor brief decompensation. He also admitted that he had been routinely using cannabis in small doses every night for the past one and a half years.
Mr. Abed began concurrent disorders counselling, and this appears to have helped. He has abstained from substances since September 2024 and recognizes triggers and the negative impacts of substance use in the past.
Submissions
Hospital counsel asserted that the fact that Mr. Abed is so uncertain about the medication he is receiving and that he is asking for a change and that that change, and the process of that change could result in a decompensation and a risk to others, constitutes a significant threat to the safety of the public.
The Crown Attorney adopts the hospital’s submissions and suggests that perhaps a six-month hearing is in order to give the Hospital and Mr. Abed the opportunity to make a controlled change to his medication.
Ms. Holder submits that her client recognizes that he needs medication to stay well and has been compliant so far. Although the evidence is that he would decompensate rapidly without medication, he does recognize the early symptoms of that illness. Ms. Holder also points out that Mr. Abed has been transparent with his team and in the past has agreed to voluntarily admit himself when troubled. Furthermore, he has a treating psychiatrist in the community in place.
Decision
The Board agrees that the prospect of Mr. Abed stopping or changing his medication while absolutely discharged is real and could lead to decompensation and a risk of significant harm to others. The recognition of this risk has come only recently to the Hospital when Mr. Abed declared he wished to change his medication. Until then, the Hospital was assured that Mr. Abed had acknowledged that any sexual dysfunction was due to psychological reasons and not medication and that his time in Iraq where he apparently performed normally, corroborated this.
As it turns out, Mr. Abed is not yet convinced and this has resulted in the hospital appreciating that if it were to give Mr. Abed his absolute discharge it is in effect exposing members of the public to a now known risk with a potential that is not speculative and that a change in medication or the very process of that change could result in Mr. Abed’s decompensation and a return to violence. The hospital is rightly concerned that if Mr. Abed continues to think that medication is the reason for his sexual dysfunction, the likelihood of his stopping medication is real, given his history of non compliance.
The Board agrees with the hospital’s position and finds that at this time a conditional discharge with the steps proposed by the hospital to assist Mr. Abed in a change of medication while under the Review Board’s jurisdiction and the hospital’s supervision is necessary and appropriate. The Board observes that even if the transition to Abilify is successful and it manages to control symptoms of Mr. Abed’s mental illness, if antipsychotic medication is not the reason for Mr. Abed’s sexual dysfunction and is caused by other factors such as stress, then at some point Mr. Abed has to be convinced of this before a serious consideration of an absolute discharge.
Furthermore, the Board expresses some concern that cannabis use might still be a factor in Mr. Abed’s life. Notwithstanding his apparent openness with his treatment team, he did not disclose one and a half years of cannabis use to them and was not as transparent with them as his counsel suggests. In his favour he has voluntarily disclosed this to his treatment team. Nonetheless, the hospital might wish to consider a testing requirement for substance use in the future.
DATED this 24th day of February, 2025, at the City of Toronto, in the Toronto Region.
Mr. C. MacIntyre, K.C.
Alternate Chairperson