Ontario Review Board
Re: Abdelaziz Abdella Abdelaziz
ORB File No: 8642
Hearing held on: Thursday, January 23, 2025
Place of hearing: Centre for Addiction and Mental Health 1001 Queen Street West, Toronto
Pursuant to: Section 672.47(1) of the Criminal Code
Before:
Alternate Chairperson: Ms. M. Labrosse Members: Dr. R. Buckingham Dr. W. Loza Ms. L. Banks Mr. W. Apted
Parties Appearing:
Accused: Abdelaziz A. Abdelaziz Counsel: Mr. T. Smith
The person in charge of hospital: Counsel: Ms. L. Senko
Attorney General of Ontario: Counsel: Ms. V. Culp
REASONS FOR DISPOSITION
(Dated March 19, 2025)
Introduction
On October 9, 2024, Abdelaziz Abdella was found not criminally responsible on account of mental disorder on a charge of first-degree murder, contrary to the Criminal Code of Canada. At the time of the finding of NCR the Honorable Court referred the matter to the Ontario Review Board for a Disposition.
On January 23, 2025, the Ontario Review Board convened a hearing at the Centre for Addiction and Mental Health, Toronto (“CAMH”) for Mr. Abdelaziz’s initial hearing under s. 672.47(1) of the Criminal Code. Mr. Abdelaziz was present and represented by his counsel, Mr. Tyler Smith. A representative from the Victim Witness Assistance Program and two of Mr. Abdelaziz’s cousins were also present.
At the outset of the hearing, the following documents were entered as exhibits:
i) Warrant of Committal dated October 9, 2024;
ii) Warrant Remanding a Prisoner dated March 22, 2024;
iii) Agreed Statement of Facts dated September 20, 2024;
iv) Consent dated June 7, 2024;
v) Curriculum Vitae of Dr. A. Iosif dated June 21, 2024;
vi) Indictment dated February 21, 2024;
vii) Psychiatric Report dated May 15, 2024;
viii) Hospital Report dated January 7, 2025; and
ix) Reasons for Judgement dated October 9, 2024.
The issues for this hearing are whether Mr. Abdelaziz represents a significant threat to the safety of the public and, if so, the Board must determine the necessary and appropriate and least onerous and least restrictive disposition having regard to the factors enunciated in s. 672.54 of the Criminal Code.
For the reasons set out below, the Board finds that Mr. Abdelaziz poses a significant threat to the safety of the public and that a detention order with privileges up to and including to enter the community of the Greater Toronto Area accompanied by staff and/or by approved person and indirectly supervised hospital and grounds privileges is the necessary and appropriate Disposition to manage the risk.
Index Offence
- “On August 26, 2023, the accused and his brother Majid were roommates. They lived with another man on the first-floor unit of an apartment building. The accused left the apartment building alone in the morning. He drove his car and stopped for gas and also at a Kitchen Stuff Plus store, where he purchased a knife and another object. He returned to the apartment building where he spent a few minutes in the car before exiting; he was doing something with his hands. Later, when the police searched the car, they located a knife sharpener on the passenger seat. The accused then entered the apartment and a commotion can be observed on the balcony. The deceased is then seen exiting the apartment while bleeding profusely from the neck. He wanders back and forth and re-enters the apartment. The roommate calls 911. The police arrive and locate the victim on the balcony, without vital signs. They arrest the accused who appears mostly calm and quiet.”
Background History
The details of Mr. Abdelaziz’s personal, legal and psychiatric history are set out in detail in the Hospital Report dated January 7, 2025. Briefly summarized, Mr. Abdelaziz is 35 years of age. He was born in Riyadh, Saudi Arabia and is the third in a line of seven sons.
Mr. Abdelaziz reportedly has two other brothers which have had serious mental health issues, possibly schizophrenia.
Mr. Abdelaziz moved to Yemen in 2010 to study civil engineering but was there for only four months before the civil war started and he had to return to Saudi Arabia. In 2016, Mr. Abdelaziz flew to the United States after being granted a visa for three months and from there, in March 2017, he took a taxi to the Canadian border and crossed it alone. Mr. Abdelaziz initially stayed in Montreal for a week and then moved to Toronto where he has lived until the time of the index offences. His older brother, Mohamed, joined him three years ago in 2020 and his other brother, Majid, victim of the index offence, came approximately one year later. Mr. Abdelaziz obtained employment as a general labourer in a factory and in an effort to increase his employment prospects he decided to finish high school in Canada in adult high school and then enrolled at Centennial College to study biomedical engineering. He was in his third year at the time of his arrest in 2023.
Mr. Abdelaziz has no criminal history predating the index offences.
Psychiatric History
Mr. Abdelaziz first saw a psychiatrist in Canada in December 2022 as he was experiencing delusional thoughts and reportedly smoking cannabis on a daily basis at that time. Mr. Abdelaziz reported “seeing versions of dirty and clean people, the Devil in people's eyes”. Records from the Michael Garron Hospital from December 2022 indicate that Mr. Abdelaziz was claiming to be able to read people’s eyes and minds and that he was not sleeping. He was put on medication. Mr. Abdelaziz had subsequent appointments at Michael Garron Hospital and eventually asked the psychiatrist if he could stop his medication and was given permission. He discontinued treatment in April 2023 and was told to go back to emergency if he needed further treatment. Mr. Abdelaziz became symptomatic several months later and reported having further auditory and visual hallucinations. The index offence occurred on August 26, 2023.
Mr. Abdelaziz’s current diagnoses include:
i) unspecified schizophrenia spectrum and psychotic disorder; and
ii) substance use disorder (cannabis) in sustained remission within a controlled environment.
Evidence at the Hearing
The hospital's evidence was presented through the Hospital Report dated January 7, 2025, and through the oral testimony of Dr. D. Jaiswal. This evidence is summarized below.
Dr. Jaiswal confirmed the contents of the Hospital Report and indicated that there were no material updates to provide other than the fact that Mr. Abdelaziz has completed a hospital group program entitled “The Forensic System” which was available to him on the Assessment Unit of the hospital. Mr. Abdelaziz has been under Dr. Jaiswal’s care since the 29th of October, 2024, when he was first admitted to CAMH.
Dr. Jaiswal explained that the hospital is not recommending any indirectly supervised community access in the Disposition due to the concern that Mr. Abdelaziz has only partial insight into the need to continue with medication, and that as recently as November of 2024, he made a request to Dr. Jaiswal to titrate the medication in order to discontinue it. Dr. Jaiswal explained that upon discussing this further with the team, Mr. Abdelaziz has agreed to continue to take medication on their recommendation. Since then, Dr. Jaiswal has noted some improvement in insight based on Mr. Abdelaziz's own self-reports.
Mr. Abdelaziz is still in the early stage of care under the forensic system and his insight is developing and has not yet been tested. His commitment to taking long term treatment remains untested. The concerns regarding Mr. Abdelaziz’s partial insight increases his risk and warrants a high level of supervision that may not be available to him if he were indirectly supervised in the community.
The hospital is not recommending the inclusion of community living, and in the opinion of Dr. Jaiswal, it is unlikely that Mr. Abdelaziz would be suitable for placement in the community over the course of the upcoming year. The treatment team needs time to familiarize itself with Mr. Abdelaziz and it will be important to see how he progresses in the forensic system, including how he deals with privileges and whether having more freedom will correspond to any increase in risk enhancing behaviours. This will require a period of observation over the better part of the next year.
Dr. Jaiswal confirmed that the team considered whether adding community privileges might be motivational for Mr. Abdelaziz in coming to its recommendations. Dr. Jaiswal understands that one of Mr. Abdelaziz’s goals is to return to post-secondary education, however, it is unlikely that indirectly supervised community privileges or community living privileges would be available to him in the next year.
Mr. Abdelaziz is currently on a secure unit at CAMH. Given the fact that it is early on in his course under the forensic system and given the seriousness of the index offence, Dr. Jaiswal is of the opinion that it is necessary and appropriate to continue his placement on a secure unit but that a transfer to a general unit could be possible within the next 12 months, likely towards the latter part of the reporting period, as Mr. Abdelaziz progresses up the privilege ladder.
In response to questions posed to him by counsel for the Attorney General, Ms. Culp, Dr. Jaiswal responded as follows:
a. He confirmed that prior to being considered for any general unit, Mr. Abdelaziz will firstly have to be put on a waitlist for transfer to a secure unit where he will be offered a high volume of therapeutic programs.
b. As he starts to access greater privileges and demonstrates ongoing stability, it is likely that the treatment team on the secure unit would ask that he be put on a waitlist for a less secure unit. According to Dr. Jaiswal, it is difficult to gauge when that might be as there is a significant waitlist, and it is likely to take several months for him to be transferred from the Forensic Assessment Unit (“FAU”) to a secure unit of the hospital.
c. Dr. Jaiswal confirmed that there have been no behavioural concerns since Mr. Abdelaziz was admitted to CAMH on October 29, 2024, and that he has engaged in the programming available to him on the assessment unit.
d. Mr. Abdelaziz has not had any privileges yet as he does not have a Disposition from the Ontario Review Board, but he has had access to the yard which is part of the FAU. Dr. Jaiswal further confirmed that it typically takes about four weeks to get through each and every pass level. Accompanied passes into the community, which is what the hospital was recommending as the outer envelope of privileges, would correspond to level 6 privileges. Mr. Abdelaziz is currently at level 0.
e. Dr. Jaiswal acknowledged that Mr. Abdelaziz has had limited access to substances given that he has been on the assessment unit but as his privileges increase, and once he is transferred to a general unit which is known to be more permeable to substances, his resolve will be better tested. According to Dr. Jaiswal, Mr. Abdelaziz has insight into the fact that cannabis and other substances can impact his mental state. It is reported that Mr. Abdelaziz stopped using substances voluntarily in December 2022 which is prior to the index offences. Based on this self-report, he has been abstinent for some time.
f. Finally, Dr. Jaiswal confirmed that, in his opinion, Mr. Abdelaziz is optimally treated on his current dose of olanzapine 5 milligrams. Since his admission to hospital, he has not exhibited any symptoms of psychosis. Given the level of clinical stability, Dr. Jaiswal does not believe that there are likely to be any medication changes, unless Mr. Abdelaziz experiences any destabilizing factors leading to the recurrence of acute symptoms of a psychotic illness.
- In response to questions posed to him by counsel for Mr. Abdelaziz, Mr. Smith, Dr. Jaiswal responded as follows:
a. He confirmed that in addition to the hospital’s concerns surrounding Mr. Abdelaziz’s request to discontinue medication in November of 2024, the hospital also considers that from a behavioural standpoint, Mr. Abdelaziz’s willingness to adhere to treatment has not been tested as his medication is currently administered to him. Mr. Abdelaziz’s medication is dispensed to him nightly by the nursing staff of the unit where he is residing. He is not being directly supervised to ensure that he ingests it but that there is no evidence at this time of him attempting to cheek his medication or dispose of it.
b. Dr. Jaiswal indicated that he had prepared the Hospital Report covering a two-month period since Mr. Abdelaziz’s admission to the hospital such that the treatment team is still getting to know him. He has demonstrated clinical stability and there has been no reiteration of the request to taper and discontinue medications as made by Mr. Abdelaziz on November 21, 2024.
c. According to Dr. Jaiswal, Mr. Abdelaziz has gained some insight. He is more contemplative of having to remain on medication indefinitely to prevent further relapse. This is positive for Mr. Abdelaziz’s prognosis. The hospital is still concerned, however, that in the longer term with ongoing stability Mr. Abdelaziz could reach the point where he feels that he no longer needs medication.
d. Dr. Jaiswal confirmed that in the NCR report, prepared by Dr. Iosif, it is confirmed that Mr. Abdelaziz’s family helped him obtain assistance when he first started experiencing symptoms of psychosis and that he was in fact brought to Michael Garron Hospital (“MGH”) by a family member. Dr. Jaiswal confirmed that Mr. Abdelaziz continues to have good support from his family. It was also confirmed that Mr. Abdelaziz had sought advice from psychiatrists at MGH to discontinue the use the olanzapine but ultimately followed the advice to continue it. Despite this, psychotic symptoms returned.
e. Finally, Dr. Jaiswal confirmed that Mr. Abdelaziz’s conduct and behaviour since admission have been excellent and that he demonstrates good engagement with the program.
- In response to questions posed to him by members of the panel, Dr. Jaiswal responded as follows:
a. He does not believe that there are any language impediments with respect to Mr. Abdelaziz's ability to access the programming available to him. Therapeutic programs do not entirely rely on written material and facilitators are able to check in with clients about their level of understanding. Mr. Abdelaziz has been assessed as having global cognitive functioning in the average range and his verbal fluency is not seen as compromised. Mr. Abdelaziz has also been observed to be cognitively bright such that the treatment team does not believe that language issues will interfere with his engagement and the benefits that he derives from programs that are available to him. Dr. Jaiswal could not confirm whether there are specifically any Arabic-speaking counselors in the hospital that can be involved with Mr. Abdelaziz but indicated that he would look into it.
b. Mr. Abdelaziz is currently on a secure forensic unit which offers on-unit psychotherapeutic programming three times per week, as well as recreational programs. This is not the full complement of what is offered at the hospital. Once Mr. Abdelaziz reaches level 2 or level 3 privileges, he would be able to attend the therapeutic neighbourhood which offers a larger spectrum of therapy programs. Dr. Jaiswal also confirmed that Mr. Abdelaziz’s current unit offers all six levels of privileges.
c. According to Dr. Jaiswal, there is no prohibition to online education on the hospital unit, however, there are limits with respect to night-time use of the internet. Patients are required to use their devices in common areas and are not allowed to have their devices in their rooms overnight. Mr. Abdelaziz has not expressed any interest in that as his focus has been elsewhere to date.
d. With respect to Mr. Abdelaziz’ diagnosis, Dr. Jaiswal indicated that, in his opinion, he likely suffers from a primary psychotic illness but it remains unclear whether a mood component might be more dominant and whether the illness is episodic in nature or persistent. Given that Mr. Abdelaziz has been stable since his admission to hospital, this has made it more difficult for Dr. Jaiswal to diagnose the specific illness. Regardless of the specific diagnosis, Dr. Jaiswal believes that Mr. Abdelaziz is currently taking the right medication to prevent the return of active psychotic symptoms.
e. If Mr. Abdelaziz was to return to substance use or be exposed to stressors that might impact sleep patterns, there is an increased likelihood of the return of symptoms. Dr. Jaiswal added that the ability to further specify the diagnosis will depend on what happens with Mr. Abdelaziz’s stability and mental condition.
f. Dr. Jaiswal stated that there is no evidence that Mr. Abdelaziz is guarded about his symptoms. The treatment team feels that he is being open with them.
g. With respect to accompanied community passes, Dr. Jaiswal confirmed that they could take place with an approved person, including those family members who have shown support and encourage him. Dr. Jaiswal confirmed that Mr. Abdelaziz is getting many visits from family members and that he is aware of the approved person process and has inquired about it. Dr. Jaiswal was asked whether he believes that family members might be at enhanced risk given that the victim of the index offence was Mr. Abdelaziz’s brother. Dr. Jaiswal does not believe that they are at greater risk in the context of continued stability, however, in the context of increased psychotic instability he would consider family members to be at increased risk.
h. With respect to substance abuse programming, Dr. Jaiswal confirmed that Mr. Abdelaziz will be strongly encouraged to participate when that becomes available to him.
i. Finally, Dr. Jaiswal confirmed that in order to be ready for transfer to a general unit of the hospital Mr. Abdelaziz will be expected to continue compliance with medication, abstinence from all substances, absence of violent incidents, engagement in programming, insight improvement on importance of medications and understanding of risk profile and demonstrated ability to exercise privileges without incident.
- Mr. Abdelaziz prepared a statement that was read out by his counsel, Mr. Smith, in which he thanked his family for their ongoing support and indicated that he looked forward to going back to live in the community to support them. He said that he is aware of his mental health and that he wished the Board to know that he only had two semesters left to complete his degree at Centennial College.
Submission of the Parties
The hospital submits that Mr. Abdelaziz poses a significant threat to the safety of the public and that a detention order with privileges up to and including indirectly supervised hospital and grounds privileges and accompanied by staff and/or approved person privileges in the community is the necessary and appropriate disposition given that it is still early days and that there are concerns about Mr. Abdelaziz’s commitment to continuing to take medication, given his previous requests to discontinue it. The treatment team has yet to see if the gains in insight will be solidified and whether he makes this request again in the future.
Counsel for the Attorney General, Ms. Culp, indicated her agreement that a detention order is the necessary and appropriate disposition, however, she urged the Board not to include the approved person community access as it is too risky at this point given that it is very early in Mr. Abdelaziz’s treatment. Given the nature and severity of index offences, as well as the diagnostic uncertainty, Mr. Abdelaziz’ family members could be at particular risk of harm. Ms. Culp indicated that she had no issue with a detention order on the Forensic Services of the hospital and/or a hybrid detention order.
Counsel for Mr. Abdelaziz, Mr. Smith, indicated his support of the hospital recommendation that community access with approved persons be permitted by the Disposition, given that Mr. Abdelaziz benefits from continued family support and that the family is very familiar with his illness. In addition, Mr. Smith submitted that the Board should add indirectly supervised community privileges on the basis that the evidence is not clear that this privilege would be inappropriate over the course of the next reporting year. The only concern of the hospital appears to be the discontinuation of medication which is based on one comment made in November where Mr. Abdelaziz requested to taper his medication. Mr. Abdelaziz’s medication is currently dispensed to him each night by the nursing staff and there is no suggestion or evidence of cheeking or otherwise not taking it. Mr. Smith added that Mr. Abdelaziz has good therapeutic relationships with his doctor, that he is not guarded, and that accordingly, the least onerous and least restrictive disposition should include indirectly supervised community access that may become available to him over the course of the next year.
Analysis and Conclusion
Having considered all the evidence at the hearing and the submissions of the parties, the Board finds that Mr. Abdelaziz meets the threshold of significant threat to the safety of the public as set out in s. 672.5401 of the Criminal Code of Canada and as further defined by the Supreme Court of Canada in Winko v. British Columbia (Forensic Psychiatric Institute), 1999 CanLII 694 (SCC), [1999] 2 S.C.R. 625.
On August 26, 2023, Mr. Abdelaziz killed his brother while experiencing a severe psychotic decompensation. This tragic incident occurred despite Mr. Abdelaziz having sought out psychiatric care for the first time, following the development of unusual symptoms in the previous months, including visual and auditory hallucinations. He discontinued treatment in April 2023 and was told to go back to emergency if he needed further treatment. Mr. Abdelaziz became symptomatic several months later leading up to the index offence.
Mr. Abdelaziz was admitted to CAMH on October 29, 2024, following the NCR finding on October 9, 2024. He is on the FAU of the hospital and has started engaging in treatment. There remain concerns regarding Mr. Abdelaziz’ willingness to continue with antipsychotic medication in the longer term. As recently as November 21, 2024, he requested to taper and eventually discontinue his medication. Mr. Abdelaziz has otherwise been cooperative and compliant and appears open to engage in rehabilitative treatment.
The treatment team needs time to get to know Mr. Abdelaziz, and to assist him in developing a more robust insight into his major mental illness and the need for long term treatment. There remains some diagnostic uncertainty, and this will be further assessed over the coming year.
Mr. Abdelaziz will need to demonstrate an ability to appropriately utilize the privileges that become available to him to be transferred to a less secure unit of the hospital, if his condition and progress warrant it during the course of the next 12 months.
These are the very early stages of Mr. Abdelaziz’s care under the forensic system following a most serious index offence, which was lethal to the victim. The Panel does not accept that indirectly supervised community privileges would be appropriate to include in the Disposition. It is unlikely that Mr. Abdelaziz would be ready for this in the coming year; however, should his trajectory improve dramatically, there could always be a request for an early hearing.
The Panel does believe it appropriate to include accompanied community passes, by staff and/or approved persons, though there are many steps to be completed before this can be achievable and exercised safely. We trust that the hospital’s approval process will be exercised carefully.
Given his family history and the severity of index offence, it would be important that there be a fulsome educational process made available to Mr. Abdelaziz’ family members to ensure safe access to the community, when he is ready.
Having considered the four factors set out in s. 672.54 of the Criminal Code, namely the protection of the public which is the paramount consideration, the mental condition of the accused, his reintegration into society and his other needs, the Board finds that a detention order in the Forensic Services of CAMH, with privileges up to and including indirectly supervised hospital and grounds privileges and accompanied by staff and/or approved person privileges in the community, is the necessary and appropriate, least onerous and least restrictive Disposition in all of the circumstances.
DATED this 19th day of March, 2025, at the City of Toronto, in the Region of Toronto.
Ms. M. Labrosse Alternate Chairperson
Office of the Registrar Ontario Review Board