Re: Babar Raja
ORB File No: 7689
Hearing held on: Tuesday, February 18, 2025
Place of hearing: St. Joseph’s Healthcare Hamilton West 5th Campus, Hamilton
Pursuant to: Section 672.81(1) of the Criminal Code
Before:
Alternate Chairperson: Ms. L. Maunder Members: Dr. S. Simpson Dr. M. Kalia Mr. R. Bigelow Mr. S. Doherty
Parties Appearing:
Accused: Mr. Babar Raja Counsel for the Accused: Mr. A. Confente Counsel for the Person in charge of Hospital: Ms. L. Barney Counsel for the Attorney General of Ontario: Ms. C. Gzik
REASONS FOR DISPOSITION
(Dated: March 31, 2025)
Introduction
On January 30, 2020, Babar Raja was found not criminally responsible on Criminal Code charges of assault (x3). At the time of the hearing, Mr. Raja was subject to an order of the Board detaining him at St. Joseph’s Healthcare Hamilton (SJHH) with privileges up to and including living in the community in approved accommodation. On February 18, 2025, the Board convened a hearing to conduct an annual review of Mr. Raja’s disposition.
The parties jointly submitted that we should maintain the detention order and privileges allowed for in last year’s disposition. One change to the term limiting contact between Mr. Raja and his mother arose during the hearing and is discussed below. The threshold question of whether Mr. Raja posed a significant threat to the safety of the public was conceded, as was that a detention order remained the necessary and appropriate disposition. For the reasons set out below, the panel agreed that significant threat was made out and accepted the joint submission.
The Index Offences
- On June 25, 2018, Mr. Raja punched three strangers in the face, unprovoked, while in a convenience store. He was aggressive in manner when the police arrived – he “took an assaultive stance and demanded that he be shot.” He was forcibly arrested.
Background / Context
Mr. Raja is a 45-year-old single man with no dependents. He has no criminal record. He is diagnosed with schizoaffective disorder as well as cannabis use disorder and alcohol use disorder, both in sustained remission in a controlled environment.
Mr. Raja immigrated to Canada from Pakistan with his parents and siblings when he was six years old. In his youth, he was not a behavioural problem and demonstrated no learning difficulties – he was a quiet child and a good student. He was accepted to university.
Around the time he started university, Mr. Raja began to demonstrate obsessive-compulsive behaviours, including compulsive handwashing. Before long he developed paranoia. He quit school. Although he worked various jobs for a time, he has been supported by Ontario Disabilities Support Program (ODSP) since 2010.
Mr. Raja’s emerging illness led to several hospitalizations. He was found naked walking in a bus terminal leading to the police taking him to hospital, for instance. In 2004, Mr. Raja was diagnosed with schizoaffective disorder. Soon after he was put on a Community Treatment Order. He was consistently treated and followed by an ACT team on a CTO for approximately twelve years. During these years he lived with his parents and had no involvement with the police. During his last couple of years with the ACT team, Mr. Raja asked and did reduce his medications. Despite some “worrisome thoughts” and an overdose of blood pressure medications (after which he immediately told his brother), he was described as stable by the ACT team. They discharged him in 2017 citing his stability, compliance with medications, good insight and good family support.
Although Mr. Raja was referred to a psychiatrist by the ACT team, he did not follow up with the referral. He relied on his family doctor for his psychiatric medications and slowly discontinued his medications. He began to use marijuana and smoked cigarettes “incessantly”. He became demanding and argumentative. His mother reported that although under the care of the ACT team he had been able to manage his finances, he was no longer able to. He ran out of money and then asked her for money, leading to conflict.
Between June 2018 (immediately after the index offences) and July 2019, Mr. Raja had five involuntary admissions to hospital and was charged with numerous criminal offences (many breaches, but also three assaults and two uttering threats). His mother described him as agitated and threatening in response to paranoid delusions. Clinical notes describe him as aggressive, extremely disorganized, and “significantly psychotic.” All the criminal charges were stayed when Mr. Raja was found NCR of the index offences.
Under the jurisdiction of the Board, Mr. Raja was stabilized on medication. He was not aggressive. He cooperated with the team. He was moved from Waypoint to SJHH as soon as a bed became available after his initial hearing. He continued to take his medications. He actively participated in programming and used his privileges appropriately.
At the time of last year’s hearing, Mr. Raja had been offered a bed at Emmaus Place. He was somewhat reluctant and was transitioning to live there slowly – he was using passes to visit and moved some things in.
The Current Year
Dr. Yuri Alatishe, Mr. Raja’s attending psychiatrist for several years, testified and adopted the Hospital Report. He described Mr. Raja as “relatively stable” throughout the year. His symptoms were well managed on his long-acting injectable antipsychotic medication. Dr. Alatishe did allow that Mr. Raja is quite guarded and despite his stable behaviour, he occasionally reveals that he likely continues to experience delusions. He has not been aggressive or used substances.
Mr. Raja attempted a very slow transition to Emmaus Place that began in December 2023 and ended in August 2024. Mr. Raja was anxious about the change. He struggled with some of the demands. For instance, he had difficulty getting organized to arrange furnishings and get groceries. Dr. Alatishe opined motivation was likely the barrier, rather than ability. Despite high support from staff, he returned to hospital early on his passes to Emmaus Place, saying he felt unsafe. Mr. Alatishe testified that although Mr. Raja was often a passive participant in activities in the hospital, he likely missed those interactions when at Emmaus Place and felt isolated. When the hospital decided that the attempted placement had failed, Mr. Raja was relieved.
Emmaus Place is a supervised living arrangement but transitional housing – meant for those who will, before long, be ready to move into independent housing. Residents prepare their own meals and are somewhat independent. Dr. Alatishe testified that the team has concluded that Mr. Raja will need higher support housing. He is on the waitlist (and has been for many years) for two group homes with support that includes meal preparation and medication management. Although Mr. Raja is comfortable in hospital, the team is optimistic that when a bed becomes available and Mr. Raja has a chance to see the home, the staff, and community, he will be amenable to the move.
In the latter half of the year, Mr. Raja began to make more use of his privileges without being prompted by staff. He still struggles with negative symptoms and tires quickly, limiting his participation.
Significant Threat
The panel accepted the uncontradicted evidence of Dr. Alatishe (supported by the rest of the team and the hospital) that Mr. Raja remained a significant threat to the safety of the public. To be clear, treated in hospital, Mr. Raja is not aggressive, threatening or violent. He is cooperative and pleasant. He does, however, remain guarded and has some “overvalued beliefs” and occasional concerning thoughts regarding his family. Mr. Raja likely experiences ongoing delusional ideation despite treatment. Mr. Raja also has a history of medication non-compliance. He continues to have poor insight into his illness and his need for medications.
We accepted that Mr. Raja was likely to fall away from treatment without the supervision and support of the forensic service. He might return to substance use. With or without substances, he would then experience worsening delusions and auditory hallucinations (sometimes commanding in nature) and become increasingly agitated, distressed and threatening. As he had in the past, Mr. Raja would likely become violent towards his family or strangers. Mr. Raja would pose a real risk of seriously harming someone through assault.
Necessary and Appropriate Disposition
The panel accepted the evidence of Dr. Alatishe that a detention order remains the necessary and appropriate disposition for Mr. Raja. Despite an available bed in transitional housing and the treatment team’s best efforts at supporting Mr. Raja with the move into the community, Mr. Raja remains in hospital – he was not ready for even supported independent housing. He awaits a bed in a group home, with more support and community.
We agreed with the parties that a detention order remained necessary and appropriate because the hospital needs to approve housing and needs to be able to return Mr. Raja to hospital quickly should his mental state deteriorate once he transitions to community living.
To date, Mr. Raja’s disposition has included a term requiring him not to communicate with his mother “except with her written revocable consent” – no doubt derived from the charges (ultimately stayed) that he incurred after the index offences, some of which featured his mother as complainant.
Mr. Raja has been communicating with his mother (with her consent) regularly for years – they talk on the phone weekly or more. His mother is his SDM. His mother has expressed no concerns with the team.
At last year’s annual review hearing, Dr. Alatishe testified that the term restricting Mr. Raja’s communication with his mother ought to remain in the disposition because the team had not discussed removing the term with Mr. Raja’s mother. This year, Dr. Alatishe testified that the restriction was no longer necessary. From his evidence, we inferred that he had not specifically discussed removal of the restriction with Mr. Raja’s mother, but he had spoken to her and she believed her son was doing well. He noted that problems between Mr. Raja and his mother had not been present for a long time. Dr. Alatishe was also confident that if issues developed around Mr. Raja’s communication with his mother, the team would be able to manage without the restriction in the disposition.
The panel concluded that the term restricting Mr. Raja’s contact with his mother (only with her consent) was no longer necessary. Mr. Raja and his mother had been communicating for years without difficulties. Mr. Raja remained in hospital. While we would have preferred to have evidence as to Mr. Raja’s mothers views on the matter, we were satisfied that the communications had not been problematic for many years and thus were unlikely to become so. We were also satisfied, as Dr. Alatishe testified, that the hospital has sufficient tools to address any issues in the unlikely event that this changes.
We encourage the hospital to discuss the removal of the term specifically with Mr. Raja’s mother. It is important that she understand the change and know she can turn to the hospital for assistance should any issues arise. The hospital can always ask for an early hearing and seek a change to the disposition if need be.
DATED this 31st day of March 2025, at the City of Toronto, in the Toronto Region.
Leslie Maunder Alternate Chairperson
Office of the Registrar Ontario Review Board