Ontario Review Board
Re: Adoum Issa
ORB File No: 7903
Hearing held on: Tuesday, March 11, 2025
Place of hearing: Centre for Addiction and Mental Health 1001 Queen Street West, Toronto
Pursuant to: Section 672.81(1) of the Criminal Code
Before:
Alternate Chairperson: Ms. S. Clapp
Members: Dr. R. Sheppard Dr. S. Lessard Mr. D. Sandor Mr. J. Cyr
Parties Appearing:
Accused: Adoum Issa Counsel: Mr. A. Rai
The person in charge of hospital: Counsel: Ms. S. Rosales Zelaya
Attorney General of Ontario: Counsel: Mr. M. Yousuf
REASONS FOR DISPOSITION
(Dated April 30, 2025)
Introduction:
On June 15, 2021, Adoum Issa was found not criminally responsible on account of mental disorder (“NCR”) on charges of assault causing bodily harm and fail to comply with probation, contrary to the Criminal Code. He is currently subject to a Disposition of the Ontario Review Board (“ORB” or the “Board”) dated March 19, 2024, whereby he is detained at the General Forensic Unit of the Centre for Addiction and Mental Health (“CAMH” or the “hospital”) with privileges up to and including community living in the Greater Toronto Area in accommodation approved by the person in charge. The Disposition also requires that Mr. Issa abstain from substance use, refrain from possessing any weapons, and refrain from contact with the victim of the index offence.
On March 11, 2025, a panel of the Board convened at CAMH to conduct Mr. Issa’s annual review pursuant to section 672.81(1) of the Criminal Code. Mr. Rai advised that Mr. Issa would not be attending the hearing; however, he had instructions to proceed. Neither Ms. Rosales Zelaya nor Mr. Yousuf objected to the panel making an Order excusing Mr. Issa from the hearing pursuant to section 672.5(10)(a) of the Criminal Code.
The Board had ordered a French interpreter to assist Mr. Issa at the hearing. Given that Mr. Issa did not attend, the interpreter was excused at the outset of the hearing.
The Hospital Report dated February 28, 2025, was marked as Exhibit 1 at the hearing. In addition to the documentary evidence, Mr. Issa’s attending psychiatrist, Dr. P. Benassi, gave evidence.
The issues to be decided at the hearing were whether Mr. Issa continues to meet the test of posing a significant threat to the safety of the public and if so, what is the necessary and appropriate Disposition, bearing in mind the four factors in section 672.54 of the Criminal Code.
Position of the Parties:
At the outset of the hearing, the parties were asked for their initial without prejudice positions. On behalf of the hospital, Ms. Rosales Zelaya took the position that Mr. Issa remains a significant threat to the safety of the public and there should be no change to the current Disposition, but for an increase in the reporting requirement to once weekly (the current Disposition requires Mr. Issa to report not less than once every two weeks).
Mr. Yousuf supported the hospital’s position on behalf of the Attorney General. Mr. Rai stated that his client also agreed with the hospital’s position. The panel, therefore, had a joint recommendation before it.
Findings:
- For the reasons that follow, the panel found that Mr. Issa continues to pose a significant threat to public safety. The panel concluded that the necessary and appropriate Disposition, which is also the least onerous and least restrictive in the circumstances, is a continuation of the existing Detention Order with an increase in the reporting requirement to once weekly as recommended by the hospital.
Index Offences:
The circumstances giving rise to the index offences are stated in the Hospital Report (at pages 11-12) and can be summarized as follows. Mr. Issa lived in a rooming house with other tenants where they each rented a room and shared a kitchen and bathroom. On April 9, 2018, Mr. Issa went into the victim’s room in the rooming house, and without provocation, stabbed him three times with a kitchen knife that was approximately seven inches long. The victim sustained one laceration to his back and two lacerations to his chest, and was transported to hospital. At the time of the incident, Mr. Issa was on probation from convictions of robbery with a weapon, disarm a peace officer, and obstruct a peace officer.
At the time of index offences, Mr. Issa stated that the “guy” he stabbed was his cousin and he had been getting into daily fights with him. He denied experiencing psychotic or mood symptoms at the time.
Background:
Mr. Issa’s personal background and history are set out in detail in the Hospital Report and will not be repeated here. Briefly summarized, Mr. Issa is a 33-year-old man who was born in Saudi Arabia and moved to Chad when he was five years old. Mr. Issa’s father had four wives and Mr. Issa has at least 10 siblings. He comes from a devout Muslim family. Mr. Issa lived in the United States before coming to Canada in 2016. He resided in Montreal with his father and brother until 2018 when he moved to Toronto. Mr. Issa is a refugee in Canada and currently holds a Canadian work visa permit. He is Arabic and French speaking, with English being his third language.
Mr. Issa obtained a high school diploma and then worked in a variety of settings such as warehouses and restaurants. He reported that his longest employment lasted three months. He is supported by the Ontario Disability Support Program.
Mr. Issa reported that in 2024, his parents arranged an engagement to a woman who lives in Chad.
Mr. Issa has medical diagnoses of malaria and diabetes. He reported smoking cannabis from time to time.
Criminal History:
- Mr. Issa’s criminal record includes convictions from 2017 for disarming a peace officer, robbery, and obstruct peace officer. He received a jail sentence, 18 months’ probation, and a weapons prohibition. The Hospital Report also stated that Mr. Issa had problems with the police in 2016 when he tried to cross the Canadian-American border.
Psychiatric History:
There is no record of any psychiatric history for Mr. Issa prior to the index offences. Following his arrest, Mr. Issa was admitted to CAMH for a fitness assessment where he presented with religious delusions and was severely disorganized. He required seclusion and was not redirectable. He was treated with antipsychotic medication and his mental state improved significantly. Mr. Issa was discharged from the hospital and followed by the CAMH Out of Custody Treatment Order Program. He was compliant with medication, and lived in various shelters. His diagnosis was schizophrenia, in partial remission, with residual symptoms.
The Hospital Report includes a summary of a hospitalization at Scarborough Health Network in 2021, prior to the NCR finding. Mr. Issa presented as religiously preoccupied, grandiose, unresponsive, and bizarre. He refused medications or blood tests and was treated on the substitute consent of his brother. The admission was described as “difficult” and Mr. Issa was placed on a community treatment order.
The Hospital Report included collateral information from a social worker who worked as Mr. Issa’s mental health intensive care case manager, which included the following (at page 7):
“Ms. Gaudreau reported when Mr. Issa is showing signs of decompensation, he becomes flirtatious with women, voices delusions of reference, fixates on religious delusions, and refuses support. Additionally, Ms. Gaudreau asserted he stops sleeping and eating properly. Ms. Gaudreau opined Mr. Issa can “become dangerous” when not on his medication. Ms. Gaudreau emphasized she has not experienced physical aggression from Mr. Issa; however, noted he has previously become verbally aggressive with his brother, on one occasion threatening to stab him.
Ms. Gaudreau informed that, when medicated, Mr. Issa functions well in the community. Moreover, she asserted he can maintain a job, and attends appointments independently.”
The Hospital Report also included information about a religiously-themed blog that Mr. Issa authors. It appears that the content and format of the blog changes when Mr. Issa becomes unwell.
Mr. Issa was found NCR on June 15, 2021. At that time, he was residing in a rooming house awaiting his initial ORB Disposition. After his ORB hearing on October 26, 2021, he received a Detention Order with privileges up to and including community living in approved accommodation. In the context of concerns about lack of insight, attempts at noncompliance with medication, cannabis use, and lack of supervision, Mr. Issa was admitted to CAMH on November 5, 2021. It was felt that he could not be managed safely in the community. He was initially admitted to a general forensic unit, but it became apparent that he required treatment under conditions of higher security, therefore, he was transferred to a secure forensic unit on November 19, 2021.
Mr. Issa’s condition slowly improved with treatment and individual therapy sessions, and he was transferred back to a general forensic unit on March 15, 2023. Mr. Issa was deemed capable of consenting to treatment and participated in multiple therapeutic groups. He earned Level 8 passes and used them to walk around the local community and attend Mosque. A functional assessment was completed in July 2023 and housing applications were initiated thereafter.
Mr. Issa’s current diagnosis is Schizophrenia. He is being treated with an Invega Sustenna injection 150 mg every four weeks.
Mr. Issa is capable with respect to treatment decisions and is capable of managing his finances.
Evidence at the Hearing:
In the fall of 2023, Mr. Issa was accepted to a LOFT residence which offered supervised and supportive mental health housing. Arrangements were made for Mr. Issa to trial the housing in December 2023; however, this was delayed due to an outbreak on the unit, and then allegations that Mr. Issa was communicating with underage girls through Snapchat and WhatsApp. The Hospital Report outlines the details of what occurred around this issue over a period of months. The end result was that while the allegations could not be proven, Mr. Issa’s opportunity to move to the LOFT housing was no longer available to him, and he was transferred to a different unit.
Mr. Issa was transferred to a different general forensic unit under the care of Dr. Benassi on January 12, 2024. Mr. Issa adamantly denied that he was involved with any inappropriate conversations with underage girls. However, Dr. Benassi testified that the treatment team found that Mr. Issa was not always forthcoming with the team about this issue, he misled them about deleting social media applications, and he often had illogical explanations. There were concerns that Mr. Issa could be difficult to monitor in the outpatient setting, and concerns that Mr. Issa’s engagement in rehabilitative programming remained limited.
In October 2024, Mr. Issa enrolled in Citi College to pursue a one-year program in business administration. He received a loan of $11,000 and attended virtual classes between October to December. However, he left the program before the 2025 semester due to financial constraints. It appeared that Mr. Issa had sent some of the loan money to his family in Chad.
Since early 2025, Mr. Issa has been resistant to engaging in programs and activities, and he started displaying negative attitudes towards the treatment team. He shared that he did not like being treated in the hospital and he did not think the team was being helpful. Mr. Issa expressed frustration and discontentment with Dr. Benassi and requested a transfer from the unit and to a different doctor. Due to increasing therapeutic relationship difficulties, Dr. Benassi asked Dr. Woodside to meet with Mr. Issa and provide a second opinion. Following this meeting, Mr. Issa backtracked his request to change teams and indicated that he would continue to work with Dr. Benassi.
However, Dr. Benassi testified at the hearing that he had reached a therapeutic impasse with Mr. Issa, therefore, his care is being transferred to Dr. Woodside. Dr. Benassi stated that Mr. Issa tends to misinterpret information and then feels slighted, and is less forthcoming. This makes it difficult to move forward, and is one of the reasons that a Detention Order is needed. He noted that this had also happened with Dr. Jones in the past.
The Hospital Report stated that Mr. Issa has been compliant with medication in the hospital and there have been no concerns about substance use over the past year. While the treatment team has recommended that Mr. Issa live in housing that has supervision and support, Mr. Issa believes that he should be discharged to independent market-rent accommodations.
The Hospital Report included the following under the heading “Re-offence Scenario” (at page 26):
“Mr. Issa’s risk arises from decompensations in his mental state, arising from his mental disorder, schizophrenia; his history of violence flows from symptoms of this illness. As he has limited insight into his illness and the need for ongoing treatment interventions, he is at risk of discontinuing his medication, which would almost certainly lead to a worsening of his psychotic symptoms, such as paranoia, persecutory delusions, disorganization and aggression. When unwell, Mr. Issa’s insight declines even further, his capacity for rational thinking is limited and his judgment is impaired. He has a history of using substances, which would likely lead to further worsening of his psychotic symptoms. When decompensated, unwell, and paranoid, Mr. Issa has a history of becoming violent and impulsive. The index offence indicates that future harm to others could be severe.”
- The Hospital Report also stated the following under “Team Review of Recommendation” (at page 29):
“In the opinion of the treatment team, Mr. Issa remains a significant threat to the safety of the public and the current Disposition remains necessary and appropriate, and the least onerous and least restrictive alternative to manage his risk. It is hoped that Mr. Issa can be transitioned to community living in the upcoming reporting period. When in the community, it would be prudent that reporting be every week. Given his limited insight, and the potential for exposure to destabilizers in the community, the hospital requires the ability to intervene early in circumstances of elevation of dynamic risk, and to approve his housing in the community.”(Emphasis added)
Dr. Benassi testified that Mr. Issa has had some positive progression in his recovery as well as a number of setbacks. The plan is to continue to look for suitable housing for Mr. Issa in the next 12 months. Dr. Benassi was clear that the hospital requires the ability to approve that housing, and also have tools available to treat Mr. Issa as an outpatient and bring him back to the hospital quickly. Dr. Benassi was of the opinion that the Mental Health Act (“MHA”) would be insufficient.
Dr. Benassi was asked about the reason for the requested change in the reporting requirement in the Disposition from not less than once every two weeks, to once weekly. Dr. Benassi responded that he was not sure where the two weeks came from because the usual practice is to have reporting weekly upon an initial discharge into the community. He also stated that Mr. Issa has not spent time outside of the hospital under the ORB, and he may need to be more urgently admitted from the community. A panel member asked Dr. Benassi about the fact that once weekly meetings is encompassed under the current wording of “not less than once every two weeks.” Dr. Benassi responded that while that was true, in Mr. Issa’s case, he believes that weekly reporting is required, and setting out the requirement explicitly sets expectations and is a helpful guide. Dr. Benassi added that transitioning to the community is a stressful time for all patients, and the team would want weekly reporting regardless of how well a person does in the community in the first year.
Dr. Benassi testified that Mr. Issa recently requested a reduction in the frequency of his long-acting antipsychotic injection, and this change was made in February 2025. Since then, Mr. Issa has been more uncooperative and irritable and slightly grandiose; however, Dr. Benassi acknowledged this could just be frustration on Mr. Issa’s part. More time is needed to see how this change may affect Mr. Issa’s presentation, and it will also be an additional consideration in terms of his transition to the community.
Mr. Yousuf asked Dr. Benassi about Mr. Issa’s insight. Dr. Benassi responded that Mr. Issa is able to identify certain aspects of his illness, but he goes back and forth as to whether he experiences auditory hallucinations or not. Mr. Issa is treated as capable to consent to treatment, but Dr. Benassi stated that are limits to that.
Mr. Rai asked Dr. Benassi about the housing options that are being explored for Mr. Issa. Dr. Benassi responded that they are putting Mr. Issa’s name forward for supported housing. He stated that Mr. Issa does not necessarily need 24-hour supervision, but the “fit” will be important.
Dr. Benassi was asked about the comment in the Hospital Report that Mr. Issa would like to be transferred to Quebec. Dr. Benassi stated that Mr. Issa attributes his failures to being in Ontario, and he believes that he would be more successful in Quebec. While Mr. Issa’s brother was in Montreal, he is in Toronto now, so Mr. Issa does not have any connections in Quebec. Dr. Benassi encouraged Mr. Issa to speak to his lawyer about this if he wants to pursue it further.
Dr. Benassi was also asked about Mr. Issa’s proficiency in English and the use of interpreters to communicate with him. Dr. Benassi responded that he has never utilized an interpreter with Mr. Issa and he was able to communicate fluently in English. He noted that Mr. Issa also attended school in English.
Analysis and Conclusion:
Based on the Hospital Report and the evidence of Dr. Benassi, the panel found that Mr. Issa continues to represent a significant threat to the safety of the public. Mr. Issa’s index offence was an unprovoked stabbing. He continues to have limited insight into his illness, its connection to the index offence, and the need for ongoing treatment interventions. Mr. Issa overestimates his abilities and can become disengaged from treatment. The panel accepted the re-offence scenario contained the Hospital Report and cited above, and concluded that Mr. Issa continues to be at risk of decompensation in his mental state which would lead to violent and impulsive actions.
The panel found that a continuation of the existing Detention Order is the necessary and appropriate Disposition, and accepted the recommendation of the treatment team and the joint submission of the parties. Mr. Issa has made some good progress this year and is waiting for appropriate housing to be available so that he can be discharged to the community. This will be a big step in Mr. Issa’s recovery, and it is important that the hospital have the ability to approve his housing to ensure that it is supervised and supported at the level that Mr. Issa requires in order to progress successfully, and to mitigate his risk to the public.
The hospital also requires the ability to bring Mr. Issa back to hospital quickly in the event of any signs of decompensation. The panel concluded that the MHA would not be sufficient to protect the public. While Mr. Issa has made progress this year, there have also been some events that have raised concerns. Mr. Issa was not as forthcoming about the social media usage as the treatment team hoped, he developed some negative attitudes towards the treatment team (such that a transfer to another doctor is being implemented), and he has withdrawn from rehabilitative programming in recent months. The recent decrease in the dose of antipsychotic medication also needs to be considered, and Mr. Issa’s mental state needs to be carefully monitored. These factors, in addition to the fact that a transition to the community can be destabilizing in light of increased stressors and independence, clearly demonstrate that a Detention Order is required for Mr. Issa at this time.
Finally, the panel accepted Dr. Benassi’s evidence that a weekly reporting requirement is required for Mr. Issa given that this will be his first discharge to the community. While Dr. Benassi stated that this is standard practice (it is unclear why reporting of not less than once every two weeks is in Mr. Issa’s Disposition), the panel concluded that it is specifically required for Mr. Issa in light of the concerns stated above regarding Mr. Issa’s current presentation and his upcoming transition to the community. Increased supervision and support for Mr. Issa during this time will be important for both Mr. Issa’s reintegration into the community, as well as for the protection of the public. The panel also considered that since Mr. Issa has not yet exercised community living pursuant to his ORB Disposition, this change in the reporting frequency will not be more onerous or restrictive for him.
DATED this 30^th^ day of April 2025, at the City of Toronto, in the Toronto Region.
Ms. S. Clapp
Alternate Chairperson
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Office of the Registrar
Ontario Review Board