Ontario Review Board
Re: Ilyes Sahed
ORB File No: 6956
Hearing held on: Monday, January 20th, 2025
Place of Hearing: Providence Care Hospital, Kingston
Pursuant to: Section 672.81(1) of the Criminal Code
Before:
Alternate Chairperson: Ms. K.A. Connidis
Members: Dr. R. Kunjukrishnan
Dr. P. Wright
Mr. A. Bouvier
Parties Appearing:
Accused: Mr. Ilyes Sahed
Counsel: Mr. M. Boudreau
Person in charge of hospital: Counsel: Ms. T. Tom
Attorney-General of Ontario: Counsel: Mr. A. Scott
REASONS FOR DISPOSITION
(Dated May 22, 2025)
Introduction, Issues, and Positions of the Parties
On May 24, 2016, Mr. Sahed was found not criminally responsible on account of mental disorder ('NCR') on charges of failing to stop for police, possessing stolen property over $5,000.00, and failing to comply with a recognizance. In 2017, he breached his Board Disposition and absented himself from hospital oversight for well over five years, until his re-arrest in 2023. He is currently subject to a Disposition of the Board dated December 21, 2023, detaining him at the Secure Forensic Unit of Providence Care Hospital (or 'the hospital') with allowable privileges extending to living in the community in approved accommodation.
On January 20, 2025. the Board convened at the hospital to conduct the annual review for Mr. Sahed. Present at the hearing, in addition to the parties and counsel, Dr. Chan, and Ms. Bryant, was Mr. Sahed’s mother, with a French Interpreter whose assistance she had arranged.
The issues to be decided were whether Mr. Sahed poses a significant threat to the safety of the public and, if so, what disposition is necessary and appropriate for him for the coming year.
The evidence at the hearing included a Hospital Report dated December 24, 2024 (the 'Hospital Report'), and the viva voce evidence of both Dr. M. Chan and Mr. Sahed.
At the outset of the hearing, Ms. Tom advised that the hospital's recommendation had changed significantly from that set out in the Hospital Report, and was that Mr. Sahed presents a significant threat to the safety of the public at this time, and that the current Detention Order should be continued, with one additional clause to provide “passes up to seven days to enter the community within a 350 km. radius of Providence Care Hospital, indirectly supervised, with an itinerary approved in advance by the person in charge of the hospital".
Mr. Scott, for the Attorney-General, supported the hospital’s position. Mr. Boudreau, for Mr. Sahed, advised that their position was that Mr. Sahed did not present a significant threat to the safety of the public and they were seeking an absolute discharge.
Index Offences on March 3, 2016
- The index offences, as set out in the Hospital Report (pgs. 2-3), were summarized in the Previous Board's Reasons for Disposition of January 11, 2024 ('Reasons'), essentially as follows:
On March 3, 2016, Mr. Sahed was observed by a police officer operating a motor vehicle in and around Mattawa, Ontario, at speeds up to 139 kph in a 90 kph Zone. He was alone in the vehicle. Police initiated a pursuit, and activated the police car siren and emergency lights, attempting to pull the vehicle over. Mr. Sahed failed to stop, and sped up.
The police terminated the pursuit for safety reasons. Other police vehicles came and a spike belt was set up. Mr. Sahed drove over it, and eventually lost rubber on three tires. He continued driving on the highway on three rims, at speeds up to 140 kph. He eventually stopped, and was apprehended without incident.
The vehicle he was driving had been reported stolen in Montreal. He had entered into a Recognizance in February 2016, with conditions including that he not be in the driver’s seat of a motor vehicle except in the presence of his surety.
Current Diagnosis, from the Hospital Report
- Mr. Sahed is diagnosed with bipolar disorder.
Personal Background
The Hospital Report should be referred to for an account of Mr. Sahed's personal history relevant to the issues at this hearing. As that Report is an exhibit, its detailed contents need not be reiterated here, but the following points are noted.
Mr. Sahed is now thirty-five years old. He was born in Algeria. His parents divorced when he was ten years old. In 2004, when he was about fifteen, he and his brother came with their mother to Canada, apparently settling in Montreal. Shortly after arriving, he bought his first guitar and began taking guitar lessons. He was noted in high school to be musically talented.
In 2007, he graduated from high school. He began journalism studies, but left the program. He worked part-time as a parking valet, but lost this job. He had relationship difficulties with his girlfriend, and their relationship ended. He worked at other jobs, also with difficulty.
In November 2007, he became depressed for a three-week period. He saw a physician who prescribed an antidepressant medication, escitalopram (Cipralex), which was soon followed by his first manic episode in February 2008. Once he stopped the antidepressant, he returned to his previous baseline state. That continued until the fall of 2008, when his depression returned. He was again prescribed an antidepressant, and again relapsed into mania.
Prior Set of Index Offences and Prior Criminal Charges
From 2009 to 2023, Mr. Sahed has a history of relapses into manic phases of his illness, leading to criminal charges, notably for dangerous driving offences, with NCR findings under both the Ontario and Quebec forensic Review Board systems, and criminal convictions in 2018.
Following is a summary of this history up to the second (2016) index offences.
In 2009, Mr. Sahed again stopped taking his medication. He reported using cannabis over the years, to an extent not clear.
At some point that year, he crossed the international border into the United States with no passport, and was arrested and spent a few months in jails there, before being repatriated to Canada.
In 2009, Mr. Sahed was charged with multiple criminal offences in Montreal (including reckless driving and failing to stop for police, as well as theft, possessing stolen property, and failing to appear in court). He was found NCR in Quebec in 2011 on these index offences, and came under the oversight of Quebec's counterpart to the Ontario Review Board, the Tribunal Administratif du Québec ('TAQ').
In 2013, he was absolutely discharged by TAQ. At that time, Quebec forensic psychiatrist Dr. Poulan reported that Mr. Sahed refused maintenance medication, even if it was minimal and reduced his relapse risk, and that without this treatment his prognosis would be poor with relapse.
In January 2016, Mr. Sahed was doing live music shows and producing his own music, spending three or four weeks with other musicians, staying up very late. He was in Toronto at some point. He became focused on wanting to move to Vancouver.
On February 9, 2016, he was arrested for breaking and entering a student residence in Montreal, where he had been squatting in a room for about a week; he was found in possession of an air-gun, and in the room were found lead balls and an air-cylinder used to load an air-gun. He was subsequently released, and no charges were laid.
On February 24, 2016, he stole a U-Haul truck in Montreal and drove off in it. He was found shortly after in Ontario, trespassing on CN property and deliberately driving on an exclusive, high-traffic, main railway line for CN freight and passenger trains, endangering the safety of the public, including railway employees. He was arrested at Newmarket, Ontario, and charged with numerous Criminal Code offences, including theft of a motor vehicle, inhabiting a hut unlawfully close to a railway line, interfering with transportation, mischief endangering life, carrying a concealed weapon (a pellet gun) and possessing house-breaking tools. Found with cannabis, he was charged under a federal statute with possession of cannabis. He was also charged under the Railway Safety Act with entering land on which railway line work was situated. He was held at the 'Lindsay prison' (Central East Correctional Centre) in Kawartha Lakes, Ontario.
Within days, his mother, very upset with him, bailed him as his surety (with conditions including the driving-alone prohibition), took him back to Montreal, and said she would get his former psychiatrist to see him in the morning. He refused, saying he did not have a mental illness. Mr. Sahed left Montreal that same night. He stole a car, in either Montreal or Valleyfield, Quebec. Set on driving to Vancouver, he headed out towards North Bay, Ontario.
His index offences followed, on March 3, 2016, in Mattawa (not far from North Bay).
Course following the 2016 NCR Finding – Hospital Oversight until November 2017
Reference should be made to the Hospital Report for a detailed account of Mr. Sahed's course under the Board's jurisdiction, from which the following points are noted.
In May 2016, the court in North Bay found him NCR for the index offences, as very likely having resulted from a manic episode. The February 2016 charges were stayed in the context of this NCR verdict.
Under his Initial Disposition, Mr. Sahed was transferred under a detention order to Providence Care Hospital's Forensic Mental Health Service. In January 2017, he was discharged from the hospital to live in the community, where he was followed by a Providence Care forensic outpatient team.
At that time, Mr. Sahed had not used cannabis for over half a year, and his bipolar disorder was in "current remission". His manic episodes were viewed as triggered by substance use. He was described as understanding the symptoms of his illness, that substance use could trigger a relapse, and how that had led to his index offences. Assessed capable of making his psychiatric medication decisions, he declined to take maintenance medication, believing that if he began to relapse he would then seek out the required mental health system contact. He completed individual psychological (CBT) treatment. A relapse prevention plan was in place for him.
In June 2017, at his first annual Board review, he was granted a Conditional Discharge, with conditions prohibiting driving and substance use, and privileges including community living allowable in both Kingston, Ontario, and Montreal, Quebec. In the fall of 2017, Mr. Sahed elected to move back to Montreal and live at his mother's, which the team supported, although it presented significant oversight challenges. He resumed cannabis use, after well over a year of abstaining, and relapsed into symptoms of mania. On November 1, 2017, his case manager, concerned about his deteriorating state, asked him to come to the hospital for an assessment. He refused. The hospital's attempts to have his mother assist in her son's return were unsuccessful. Mr. Sahed thereafter stopped all contact with the hospital and Board, stopped adhering to his Disposition, and stopped attending Board hearings. Despite all efforts made, he was lost from hospital oversight and Board contact until June 2023.
Course during his Unlawful Absence – November 2017 to June 2023
The course of Mr. Sahed's unauthorized absence ('UA') from hospital oversight under the Board's jurisdiction, as set out in the Hospital Report and in the previous Board's Reasons for Disposition, need not be reiterated here, but is summarized as follows.
After his UA on November 1, 2017, his mother reported (in an interview some six years later) that initially his mental health was stable and he had a job. It was also reported that within a month of that date he engaged in extremely dangerous driving in Montreal, putting all those in his wake in grave danger: After stealing gas, he thwarted police attempts to stop him by driving into a multilevel parking garage, where he accelerated towards officers who had got out of the police cruiser, forcing one to jump away to protect himself, and hitting the cruiser and breaking its window; the officers then used the cruiser as a protective barricade, and he again accelerated towards them, crashing into the cruiser's side door. He exited the garage and drove at high speed on city streets, through a designated school zone and a barricaded construction site, almost striking other vehicles on the roadway. Police canceled the pursuit. Mr. Sahed was arrested later that day, and charged with dangerous driving and assault with a weapon.
The updated CPIC at last year's Board hearing showed Mr. Sahed having "convictions in January 2018, as well as the associated custodial sentence" in Quebec. This is apparently in relation to these serious charges in late 2017.
In 2018, his mother later reported, he began using cannabis again, and his mood deteriorated into symptoms of mania. He was admitted to a Montreal hospital overnight, and then discharged with a recommendation to reconnect with Providence Care, which he never did.
In 2020, Mr. Sahed travelled to Algeria to visit his ill grandmother, staying with his uncle. There, he had a manic episode, with symptoms including psychomotor agitation, grandiose thinking, and aggressive behaviour. Cannabis use was felt to be a factor in the episode. Against his wishes, his uncle arranged for him to be taken to hospital, he was admitted from February 5 to May 20, 2020, and treated with risperidone and carbamazepine antipsychotic medications. He slowly improved, and was discharged on the carbamazepine medication.
He returned to Canada later in 2020. Back in Montreal, he took his medication for a while and then came off it. He was connected with an outpatient clinic where he saw a family physician for about two years, apparently until sometime in 2022.
In February 2023, after travelling to the Bahamas and Turks and Caicos islands, Mr. Sahed returned to Canada. At Ontario's Pearson International Airport, he was arrested on an outstanding warrant, charged with failing to comply with a release order (subsequently withdrawn), and again sent to Lindsay prison in Kawartha Lakes. After being released from prison, he "began his journey through Northern Ontario."
On June 6, 2023, Mr. Sahed was stopped by police in Marathon, Ontario, driving recklessly in a construction zone with workers present. He was charged with disobeying a court order, having breached the driving prohibition in his extant Board Disposition (charge subsequently withdrawn).
Course from June to December 14, 2023 – the first Board Review since 2017
On June 9, 2023, Mr. Sahed was arrested pursuant to the outstanding Board Warrant, and was returned by police to Providence Care Hospital. There, he was seen as having elevated mood symptoms but not full-blown mania, thus not meeting Mental Health Act criteria for involuntary admission. He left hospital against medical advice. He explained at last year's Board hearing (previous Reasons, para's 55, 71) that he left because "he did not know how long he would be detained and he did not want his freedom deprived."
Mr. Sahed was thus back in the community on June 14, 2023. Shortly after that, he was charged with two property offences: On June 17, he and another man were charged with break and enter into a yacht at a marina in Barrie, Ontario, from which they stole food and alcohol. On June 19, he was charged with an earlier theft of personal items at a Barrie work site.
At some point, he returned to his mother's home in Montreal. On July 7, 2023, his mother contacted Kingston police, to advise that her son had wanted her to take him to get his impounded car and belongings from the Kingston area, but she did not retrieve his car, to ensure he did not drive anywhere, and that he was quite unwell, paranoid and in a manic state, and she believed he was a risk to himself and the public.
On July 16, 2023, his mother reported that he had taken her car without consent, and had not taken his medication for about a month. On July 17, police located him driving the car in Valleyfield, Quebec, tried to pull him over, and he sped off and engaged in a very dangerous and prolonged attempt to evade them. He drove at high speed, zig-zagged between cars, U-turned and cut off motorists, drove on the wrong side of the road in dense traffic, and ran 4-way stop signs. He was arrested and charged with car theft, dangerous driving, and failing to stop for police.
On August 2, 2023, he again stole his mother's car, intending to drive to Vancouver. He ran out of gas near Wawa in northern Ontario. He broke into a motel there, stayed the night, stole food, left the room in complete disarray, and stole a mountain bike. He was arrested, found with cannabis in his possession, and charged with break and enter, mischief, and two thefts.
A Board Warrant was executed, and on August 5, 2023, police returned Mr. Sahed to Providence Care Hospital in Kingston. Evidence was gathered respecting the new charges. Risk assessments were made. His first Board review since 2017 took place on December 14, 2023.
During the four months preceding the 2023 hearing, Dr. Chan found Mr. Sahed to be, not in a bipolar relapse, but passionate and forceful in his positions, overconfident, guarded at times, and lacking insight. His behaviour on the unit was mostly stable. He declined to take medication in that "prison setting", but hinted that if he was in a community setting he might be more receptive. His mother indicated that her son had not returned to his baseline and his mood was still somewhat elevated, and that he had been treating her poorly, such as yelling at her in phone calls.
The December 2023 Board review resulted in the finding, based on the evidence of both his attending psychiatrist Dr. Chan and clinical psychologist Dr. J.C. Rose, that Mr. Sahed posed a significant threat to the safety of the public. The current Disposition was issued, a detention order, with substance use, driving, and weapons prohibitions, and with privileges up to indirectly supervised passes into the Kingston community within 20 kms of the hospital, and living in approved accommodation in the community, reporting at least once a week.
Course over the Past Year, December 2023 to December 2024, and Risk Assessments
Reference should be made to the Hospital Report for a detailed account of Mr. Sahed's course over the past reporting year, from which the following points are noted.
In December 2023, after he had begun cooperating in a trial of aripiprazole (a mood-regulating antipsychotic medication taken daily in oral form), Mr. Sahed agreed to and switched over to a long-acting injectable ('LAI') form of the medication given once every four weeks. His mood and mental state settled quickly and remarkably well; by early 2024 he was less 'testy', could see the benefit of the medication and its calming effect on him, and began to cooperate fully with the team. He has continued receiving this LAI medication since then.
With that positive change, privileges were granted and gradually increased, up to indirectly supervised day passes into the city of Kingston. He and his mother have had good visits, no longer with arguments. He has been relating well with staff and other patients in hospital, and making use of the library and internet there.
Financial support for Mr. Sahed was an ongoing concern this past year. His team social worker, Ms. Brittany McDonnell, worked with him on applying for a monthly disability pension from the Ontario Disability Support Program ('ODSP'). The application was submitted to ODSP, but remained under review there, delayed and complicated by a number of factors. The factors were an extreme backlog in processing pension applications at ODSP; Mr. Sahed's receiving payments from the counterpart Quebec disability support agency until April 2024; the difficulty in obtaining information from the Quebec agency, and Mr. Sahed's difficulty in obtaining his banking information and opening a local bank account.
Mr. Sahed was motivated to obtain and submit the documentation for the ODSP pension. While his application remained under review, he received no pension, but apparently did receive some ODSP funding to cover some expenses for community engagement over the fall of 2024. The lack of an ODSP pension is reported to have significantly delayed Mr. Sahed's progress, by limiting his ability to enjoy community activities in Kingston, blocking his access to the community housing his team had hoped to accomplish, and thus impeding both his willingness to enter the community on passes and his community placement.
Mr. Sahed engaged in individual programming to address his bipolar illness, relapse prevention, coping with stress, addiction recovery, and learning his way around Kingston, with his team occupational therapist ('O.T.'), Mr. David Montesano. Mr. Sahed made substantial gains in developing insight into his psychiatric struggles, and in particular, is described as now knowing that he needs to continue maintenance medication going forward, and not only if he feels it is necessary or is in an acute hospital care setting.
There has been concern about Mr. Sahed's pattern of excessive sleeping. He slept through his December pre-Board team conference, and is described as sleeping to an astounding extent.
Two differing risk assessments were provided in the Hospital Report. In Dr. Chan's assessment, Mr. Sahed no longer presented a significant threat to the safety of the public, having accepted the recommended medication treatment and continued with LAI aripiprazole every four weeks for the past year, with good results in controlling his mood disorder, and having done very well generally for the entire year, with no risk concerns.
Dr. Chan noted that Dr. Rose had informed the team her view was unchanged, that an absolute discharge would be premature, given Mr. Sahed's history when living in the community, and his risk variables being untested in the community, and that she was not optimistic the conditional discharge framework that failed in 2017 would work now. In brief response, Dr. Chan noted that Mr. Sahed is not the same individual he was when he relapsed into mania in 2017, as his mood disorder is now controlled by the medication, and that the lack of data about his safety in the community was no fault of his own but due to the delay in his community transition resulting from the difficulties in obtaining ODSP funding.
Lengthy extracts from Dr. Rose's subsequent Psychological Risk Assessment Report (or 'Report'), dated December 9, 2024, are included in the Hospital Report.
Dr. Rose's Report sets out in detail the results for Mr. Sahed on two actuarially-based guides for structuring violence risk assessment: the Level of Service Inventory-Revised ('LSI-R') and the Historical-Clinical-Risk-Management-20 ('HCR-20').
The LSI-R results indicated his criminogenic risk and need factors within the next year were in the low/moderate range, and that his main needs for addressing his risk were in the education and employment, leisure, emotional and personal, and financial domains.
The HCR-20 results identified numerous risk factors for violence, described with examples in Dr. Rose's Report. Of the ten historical risk factors, five were indicated to be present (violence in dangerous driving, other antisocial behaviour such as focused threats and intimidation, cannabis use, major mental illness, and poor treatment and supervision response) and two possibly or partially present (sporadic employment history, and violence threats and property offending to get his immediate needs met). Only one of the five current risk factors was possibly or partially present (lack of insight into his violence risk and seriousness of his offences). All five future risk management risks were noted present or possibly or partially present, in the event of an absolute discharge or living in Montreal under a conditional discharge (future problems with professional services and plans, treatment and supervision response, his living situation, personal support, and stress and coping ability).
Also identified in Dr. Rose's Report are potential motivating, disinhibiting, and destabilizing factors for violence and violence-management. Potentially motivating factors include that he (1) may be drawn towards violent and criminal behaviour and (2) may have negative attitudes towards authority (and not only in the context of mania). Potential disinhibiting factors that may lessen his restraint from violence include his (1) cannabis use in particular, as well as (2) negative peer influences and (3) desperation for immediate needs for shelter and safety. Destabilizing factors that may impair his decision-making include his (1) active symptoms of mania, and mania with psychotic features, (2) losing insight when unwell and rejecting reliable advice from others, and (3) acute intoxication, especially in the context of mania.
On these results, Dr. Rose concluded that Mr. Sahed presented an at least "moderate risk" for future violence overall, and that an absolute discharge would be premature, particularly given his history of non-compliance with his Board disposition, his six-year UA, and his reoffending.
At the same time, Dr. Rose expressly recognized the positive gains Mr. Sahed made this year, and stressed that her assessment was not meant to discount those gains, but rather to ensure that his known risk factors would be addressed in a gradual reintegration into the community with regular and close monitoring under the 1:1 supervision of a hospital treatment team.
Viva Voce Evidence of Dr. M. Chan
- Dr. Chan, a co-author and co-signatory of the Hospital Report, has been Mr. Sahed's treating psychiatrist since September 2023. Dr. Chan confirmed he has reviewed the prior records relating to Mr. Sahed, and testified further in chief, in summary, as follows:
(a) Mr. Sahed had begun taking medication since the last Review Board in December 2023, and agreed then to switch to the injectable form of his medication, for which Dr. Chan chose the lower dose available, of 300 rather than 400 mgs. There have been no side effect problems, and Mr. Sahed is very happy with the outcome of the medication.
(b) In the past, Mr. Sahed was adamant that he would receive medication only when he was released into the community, and would only start it at the time of his choosing. He is considered capable to consent to his own treatment and it could not be forced on him. He was also very passionate that he should not be under the Ontario Review Board system, and that it was very unfair that he was not free to go to the legal system.
(c) In contrast, now Mr. Sahed is no longer adamant in that medication approach. He has settled right down. All the passion and argument has eased off. He has agreed he is feeling better. He has said to Dr. Chan that he is less prone to push back at him, and Dr. Chan can see that. Dr. Chan has discussed his need for life-long commitment to his medication with him. Mr. Sahed has said he could see Dr. Chan’s points were valid and the medication was helping him.
(d) It was Mr. Sahed's mother who noted this difference in the past year, and who had said in 2023 that he was not back at his baseline yet. Dr. Chan took note of that, and began to see that Mr. Sahed's adamant argument about his medication was his illness. This had not been apparent when he was actively ill.
(e) Mr. Sahed is now doing fine. He has moved along since 2017, when he was unmedicated, had a manic relapse at home in Montreal, and was AWOL for six years.
(f) Dr. Chan was surprised by this change in Mr. Sahed this past year. This was why, in his risk opinion in the Hospital Report, he was of the view that Mr. Sahed did not represent a significant threat to the safety of the public. That was based on Dr. Chan's clinical impression since his involvement in 2023.
(g) Mr. Sahed's bipolar diagnosis goes back years, to 2010 in the Province of Quebec. All the ups and downs since his discharge in 2013 from the Quebec TAQ have resulted from his very poor record of medication compliance.
(h) Dr. Chan noted that history, highlighting that after a short stay in Providence Care Hospital in 2016, not taking medication, he appeared to be doing well. He was discharged, untreated, to live in the community in 2017. He went AWOL in Quebec. In 2020, he was treated with medication in hospital in Algeria for some months, then returned to Canada. In Montreal he connected with a clinic where he saw a family physician for about two years, got his medications for a while, and then came off them. He did not see a psychiatrist. There was no way Providence Care could get him back to Ontario. He was AWOL until 2023.
(j) Since he has been back in hospital, Mr. Sahed has had a very good year. He has been exercising community privileges with no substance use or other concerns. The team was very eager for him to move forward from last year, and he has done that this past year.
(k) Mr. Sahed has insight now. He recognizes his driving offences in 2016 and 2023 took place when he was not well. His biggest risk is when he is behind the wheel of a car, manic, and police are trying to stop him. He recognizes that at those times he got into a lot of trouble, and it has cost him a lot. He recognizes that he has to take medications, and not only when he is unwell: to stay well, he will still need to take his medications.
(l) There has been no problem of interpersonal physical altercation with Mr. Sahed.
(m) On the funding difficulties in 2024, Mr. Sahed's ODSP pension application was only approved in January 2025, a few weeks before this hearing. All of last year, he had struggles with his income source between Quebec and Ontario, and had not been approved for ODSP benefits, due to backlogs in Ontario and practical challenges in trying to provide Ontario with his Quebec funding records and his banking information.
(n) This lack of ODSP funding meant that Mr. Sahed could not move forward to community living in 2024. That was not held off for any clinical reason, but because it was unaffordable. If he had had an income source available, the team would have been eager to support his transition to community living.
(o) Mr. Sahed said he could not do much in the community because he had no money. To an extent, he was absolutely right about this. He had funding for a bus pass to go to the gym and library, but that ran out in October 2024. He could not even buy a coffee for himself.
(p) When asked about his excessive sleeping, Mr. Sahed told Dr. Chan it was not because he was depressed, but all because of this funding problem, which he coped with by sleeping until after lunch, and engaging in technology (such as on the computer and gaming) in the hospital. Dr. Chan was disappointed that he has not made an effort to go out for a walk.
(q) On the significant threat issue, Dr. Chan explained that his earlier opinion in the Hospital Report had been primarily based on the limited time frame since 2023, when Mr. Sahed has been on medications back in the hospital. The team's conclusion on significant threat had not been unanimous. Dr. Rose disagreed with Dr. Chan, and was of the view that Mr. Sahed should follow the usual pathway to move into community living, and be able to show that he could function in the community context.
(r) The problem is that Mr. Sahed has a history: The symptoms of his diagnosis were not recognized – from his AWOL in 2017 until the summer of 2023 – when, in hindsight, he was in a manic relapse which was not addressed. To overcome that history, he needed to demonstrate he could do well in the community. But with no funds, unfortunately that could not be tested. He also did not make full use of the privileges he did have.
(s) As to the change in his opinion on significant threat, Dr. Chan explained that, clinically, he is pleased with Mr. Sahed's course, who is very well, having turned a major corner with his medication, and with not one bit of relapse seen since then. At the same time, Dr. Chan agrees with Dr. Rose that Mr. Sahed has not fully demonstrated he is ready for discharge, and that, looking at it from that perspective, there are a lot of variables to consider. Dr. Chan characterized his earlier position as more narrowly focused, and Dr. Rose's as broader. Taking all of that into account, his opinion is that, for the future, an absolute discharge would depend on Mr. Sahed staying on the path he is on now.
(t) With respect to the recommended disposition terms and the plans for the coming year, Dr. Chan stated the importance of the hospital being able to return Mr. Sahed to hospital under a detention order. He noted Mr. Sahed's history of needing a structure to work within, and what is known of his driving behaviour. Under his conditional discharge in 2017, he was not able to be brought back into hospital under the Mental Health Act, and so it had not been possible to address his relapse into mania.
(u) Dr. Chan recommended that the driving prohibition in the current Detention Order be continued, noting Mr. Sahed's driving history in 2023, and not being aware of any criminal court orders preventing him from driving. Dr. Chan also noted that Mr. Sahed had felt the driving prohibition in his Board disposition only applied in Ontario, not Quebec, and driving was unfortunately part of his employment in Quebec as a food delivery driver. Mr. Sahed is aware that he has to address the concerns in Ontario before he can go back to Montreal.
(v) If a significant threat finding is made, the team would proceed with Mr. Sahed's transition to community living. His ODSP funding has now been approved and will likely start within a couple of weeks of this hearing. Then they could begin the search for housing for him, with no need for a supervised setting. Mr. Sahed could get involved in the community.
(w) If Mr. Sahed were to be absolutely discharged, his mother has agreed to help him with the transition, with a place to live and financial support.
(x) With respect to his mental health care in the community if he were to return to Montreal, Mr. Chan had just spoken earlier in January with the family doctor who provided care for Mr. Sahed for about two years after he was in Algeria in 2020. She was aware of his history, and willing to take him on for treatment. There were psychiatric consultants who came to her practice in-house. Mr. Sahed had not previously engaged with any psychiatrist.
(y) Mr. Sahed said to Dr. Chan that he would be happy to go to that family doctor, and to have psychiatric care through that medical practice. Taking psychiatric medication treatment would be voluntary for him, whether he was living in the community after an absolute discharge or under an Ontario Review Board disposition, given his capacity to make his own treatment decisions.
- In answer to questions from Mr. Scott, for the Attorney-General, Dr. Chan testified:
(a) If Mr. Sahed was not optimally medicated, he would be at significant risk of relapsing and getting into driving offences. Dr. Chan agreed that the index offence and Mr. Sahed's other driving offences were very serious and potentially catastrophic, and that in 2023 in Quebec, Mr. Sahed incurred charges of very dangerous operation of a motor vehicle. While Dr. Chan noted that these are still allegations that have not been proved in court, he agreed that they form part of his own risk analysis.
(b) Mr. Sahed's history of dangerous driving offences was put to Dr. Chan: from 2009 in Quebec, when he was manic and found NCR; the 2016 index offence in Ontario; the November 2017 dangerous driving in Quebec, and the July 2023 unadjudicated risky driving in Quebec. Dr. Chan agreed that these all related to Mr. Sahed being in a manic episode, and that there is a reasonably long lasting pattern of dangerous driving and risk when Mr. Sahed is not optimally treated and has relapsed into mania. Dr. Chan agreed that these risks are sizeable and could include death.
(c) Respecting Mr. Sahed's history of coming off medication, Dr. Chan noted that in Ontario he never went on medication and thus had no instance of stopping it. In Quebec, as Dr. Chan understood, for a while Mr. Sahed was medicated but he did not stay on his medication; this, Dr. Chan agreed, was the outcome when no framework was in place. Mr. Sahed's history of refusing or going off medication was put to Dr. Chan, noting three documented examples, for a lengthy time in 2013, in 2016, and in 2020, when he went of his medication or refused to take it, notwithstanding or contrary to his proposition that he would continue on with it. Dr. Chan replied that Mr. Sahed's history works against him, and noted that he appears to have made a significant shift since he had been on medication last year.
(d) Dr. Chan confirmed that the team have been trying repeatedly to encourage Mr. Sahed to exercise his privileges more, to demonstrate more of his stability, and that he did not show the initiative Dr. Chan was hoping for.
(e) When asked if he thus had concerns that Mr. Sahed might not continue on his medication, Dr. Chan replied that he had actually been very pleased with Mr. Sahed's engagement with medications. There was a reason Mr. Sahed had not gone out on his privileges, although maybe he could have done more. Dr. Chan was more optimistic about the medications, and does think Mr. Sahed has learned.
- In answer to questions from Mr. Boudreau, counsel for Mr. Sahed, Dr. Chan testified:
(a) While Mr. Sahed could have used more of this community passes. Dr. Chan agreed that he did go to the gym and Tim Horton's, and did respect all the conditions of his passes when using them. He did very well when he decided to use his passes, and there were no concerns with supervision. Dr. Chan confirmed he had no reason to doubt Mr. Sahed's explanation that he did not use the passes because of a lack of funding.
(b) Dr. Chan confirmed that he was familiar with Mr. Sahed and well aware of the hospital file and Mr. Sahed's previous record when he wrote his assessment. In explaining why he changed his risk opinion, Dr. Chan noted that Dr. Rose's approach was a broad perspective with great detail about Mr. Sahed's past history, while his own focused on Mr. Sahed's good progress this past year, when he has done so well, being on the medication, with no arguments about it as there used to be, and no problems at all. Dr. Chan had advocated strongly for Mr. Sahed; however, he could not overcome his past history.
(c) Dr. Rose agreed Mr. Sahed has done well this past year, but in her opinion it would have been optimal to solidify his community living. This difference has to do with time-frames: Dr. Chan's is more limited, like a snap-shot, and he acknowledges that. While he has every confidence Mr. Sahed will do well, he cannot say with certainty whether he will do well or not. Dr. Chan stated he supports Dr. Rose's wide-angle lens.
(d) Dr. Chan would need to see Mr. Sahed keep to what he is doing now in hospital, when he has moved to living in the community, and Dr. Chan has every confidence that he will be able to do that. Mr. Sahed has not done all he could do as a patient in the community, in not using his community passes to the fullest extent, and in his sleeping and at times not coming to conference, for example, having slept through he pre-hearing conference for this hearing. Dr. Chan sees Mr. Sahed once a month, and this is pretty much the extent of the problems.
- In answer to questions from Board panel members, Dr. Chan testified:
(a) Mr. Sahed's first dose of Abilify was in December 2023.
(b) Dr. Chan agreed that, given bipolar disorder is a cyclical disorder, it is difficult to predict how well medication is doing when there might be break-through symptoms. Dr. Chan could see, in hindsight, that Mr. Sahed's passion had been a symptom of low-grade mania; in the past, they thought he was stable at that time, but within a month he was manic. This can be a challenge for Mr. Sahed, too, and this was a dilemma for Dr. Chan. Dr. Chan agreed that, if his symptoms resurfaced, another psychiatrist who did not know Mr. Sahed might miss that these were low grade symptoms of mania.
(c) The 2023 incidents in Ontario arose from Mr. Sahed having the idea of getting married to a woman in Dubi he met on-line; he thought it was cheaper to fly there from the Vancouver airport, and got the bright idea to drive across Canada to fly from Vancouver. Mr. Sahed was in a sustained manic episode at that time. The same police were involved in both of his driving incidents in Ontario. There were also property offences, staying in a hotel, break and enter, having no money, and so on, which Mr. Sahed explained by saying he needed to survive somehow.
(d) Mr. Sahed's eventual goal is to return to Montreal. To establish community living there, he would need to find community housing there, and receive a subsidy. He does not need transitional or supervised housing, and could potentially live independently.
(e) If Mr. Sahed is able to live independently and stably in the community for the next year, with no changes to the path he is on now, Dr. Chan indicated he would then be in a position to argue that there is no longer a significant threat.
(f) With respect to Mr. Sahed's history and the change in Dr. Chan's risk assessment and recommendation, Dr. Chan confirmed that Mr. Sahed's psychiatric history began in 2007, when he was eighteen years old, had become depressed, was treated with an antidepressant medication, and he then switched to mania.
(g) Dr. Chan confirmed that he was not recommending a conditional discharge at this time.
(h) At the time of going absent without leave in 2017, Mr. Sahed had a detention order, with community living, and a driving prohibition, just as he has now in his current Disposition.
(i) Dr. Chan viewed Mr. Sahed's taking cars, just prior to his dangerous driving incidents, as being part of the result of his manic episodes.
Viva Voce Evidence of Mr. E. Sahed
- In examination in chief, Mr. Sahed confirmed that he had read the whole Hospital Report, he recognized his diagnosis there, and the Report correctly reflects the last months and year. He testified further in chief, in summary, as follows.
(a) The biggest factors that trigger his manic episodes are smoking weed and being off the treatment. He confirmed he was undergoing some treatments now, and said he thinks he will need medication for the rest of his life to stay stable. To avoid relapses, he would keep taking his medication, have a stable life and a stable job, and exercise, and that is it.
(b) If the Board gave him a discharge, he would go back to his mother's, who is really supportive. His plan would be that after one or two years there, as soon as he could find a good job, he would get his own apartment.
(c) With respect to his community passes, Mr. Sahed said he has been really good in exercising them: going to the gym, the library, and the coffee shop; complying with all the rules, and never made one mistake.
(d) He would reassure the Board that he would not do what he did in his past history anymore, by the fact that this past year he never took off, and he wants a stable life, wants to be treated, and wants to get out of all these problems. As to being tempted to drive, he does not want to be driving until he has his absolute discharge.
(e) As to what employment or education he would seek, Mr. Sahed referred to having studied architecture, or taking a customer service kind of job, but not to be a delivery guy anymore.
(f) He agreed that the lack of money was the reason he could not enter into the community more completely.
(g) Respecting sleeping in late and not going for walks, he explained this was because he did not have any funding. He had some family help, but that was not enough. He applied for ODSP. He went two or three times a week, to the gym or library. His passes were for six hours and he would be out for four or five hours. He had drug tests every three weeks.
- In answer to questions from Mr. Scott, Mr. Sahed testified:
(a) In 2013, when he was under the Quebec review board and had an absolute discharge, it was not that he had stopped taking prescribed medication: he had been offered it but refused it, because the anti-depressants in 2007 and 2008 put him into manic episodes.
- In answer to questions from the Board panel, Mr. Sahed testified:
(a) Respecting the programs he has been taking for relapse prevention, coping with stress, and addiction recovery, Mr. Sahed said he has been learning a lot of things, learning coping strategies to avoid using any drugs. Asked if he could be more specific, and what he learned about himself, Mr. Sahed said he learned he could do a lot of things other than using drugs, for example, music or a job.
(b) When asked if he was familiar with "a prior capable wish" agreement – in which a person capable of consenting to their own medication could agree that, if their state deteriorated, they would put away their right not to take medications – Mr. Sahed replied that he could sign that for sure, he would agree to that being done if he was unwell. It was clarified that this approach, referred to as a "Ulysses clause", has been used under the Ontario Mental Health Act, to enable a person who is treatment capable, such as Mr. Sahed, to agree when he is well that, in the event he becomes unwell and has lost his insight, he consents to be given treatment even if he refuses. This is done to avoid delays in receiving medication while appeals proceed about capacity to consent.
- That concluded the evidence presented at the hearing.
Closing Submissions
In thorough closing submissions, the parties addressed the contested points on the issues of significant threat and the disposition and its terms.
On behalf of the hospital, Ms. Tom addressed the reversal of the hospital recommendation, and Dr. Chan's articulation of his risk assessment, both in the Hospital Report and in his evidence given at the hearing in light of Dr. Rose's Report. Ms. Tom pointed to the support in the evidence at the hearing that Mr. Sahed's changes of the past year were insufficient to mitigate the risk of harm, because the risk history referred to was recent and not a long time ago, and the recent changes have not yet been tested in a less-supervised setting than the hospital.
The risk relating to medication is not simply Mr. Sahed's past refusal to take it, but whether he will now continue to adhere to it. The offences were very serious and put peoples' lives in danger. The circumstances of the July 2023 offences, while not adjudicated yet, make it clear that Mr. Sahed would do whatever it took to escape the police and not go back to hospital. The public has been lucky for ten years.
Ms. Tom applauded Mr. Sahed for this good year he has had, and the insight he has shown into his illness and need for medication. At the same time, Ms. Tom stressed that this must be tested in the community, and that this concern is not speculative; what is speculative is to support an absolute discharge without testing whether Mr. Sahed's insight will translate into action and he will actually engage as needed.
The hospital is looking to transition Mr. Sahed to live in the community. That was tried in 2017, he was given a conditional discharge, he absconded, and in the six years after that, there were recurring police involvements and Board orders, to no effect. Ontario's Mental Health Act system could not return him to the Board's oversight. Meanwhile, he was driving in his work in Montreal. Ms. Tom also noted that his deterioration may be hard to pick up; only this past year, Dr. Chan saw that Mr. Sahed's struggle around medication was an early symptom of mania.
With respect to the disposition, Ms. Tom submitted that only a detention order is realistic, and reiterated that there is nothing speculative about that. While Mr. Sahed's mother has been a constant in his life, for a period of time during his AWOL, his family disengaged from Providence Care Hospital as well; hopefully, the change now will continue. At this time, the only way his significant threat can be managed is to continue Mr. Sahed's current Detention Order, with a transfer to the community, and with seven-day passes to Montreal, where his family is.
On behalf of the Attorney General, Mr. Scott fully adopted Ms. Tom's submissions, and wished to underscore a number of the factors.
The risk is acute, and the pattern is clearly seen – in the 2009 index offences; the February 2016 charges and the March 2016 index offences; the November 2017 dangerous driving and assault with a weapon charges following his AWOL, and the 2023 incidents in Quebec. All are clearly linked to the manic phase of his mental disorder. There is no issue about this.
The risk is tied to management of his medication, and whether or not he will continue to take it. There is a significant supervisory framework he is under right now, and he has not had substantial access to the community yet. Therefore, it is speculative that he would continue to take his medication: this is not documented to have happened when he has been in the community, and this history is not all old history. There is a real risk that he will not continue his medication. We know the risk to the police and others from Mr. Sahed's driving conduct. The risk is clear. He needs to continue to work with his team.
On behalf of Mr. Sahed, Mr. Boudreau submitted that the risk to the safety of the public is not acute. Mr. Boudreau noted many positive achievements of Mr. Sahed, describing him as having proved we can trust him, because he has been his antipsychotic medication for the past year and said at the hearing that he will need medication for the rest of his life; because he has developed very good insight this last year, committed to his treatments, done everything he had to do the past year, and his is a very encouraging picture now, with a very bright future.
Therefore, Mr. Boudreau stressed, a detention order does not make sense. He submitted that Dr. Chan gave a very weak reason at the hearing for changing his initial opinion in the Hospital Report, from no significant threat and an absolute discharge, not even needing a conditional discharge, to a detention order. Mr. Boudreau submitted that it has not been demonstrated that Mr. Sahed could not return to the community; it is not necessary for him to have a plan in the community, or a residence there, or to prove he is not a significant threat. In Mr. Boudreau's view, the only reason given for not granting Mr. Sahed an absolute discharge and giving a detention order, is that he has not been actively in the community for a couple of months.
Mr. Boudreau stressed that Mr. Sahed is a very different person today from the past. He noted that Mr. Sahed has plans for his future: to go to his mother's, then get a job, not use any drugs, and stay on his medication for bipolar illness. He asserted that the Ontario Review Board has to trust Mr. Sahed, and cannot give a detention order lightly.
If not an absolute discharge, Mr. Boudreau advocated strongly for a conditional discharge, especially given the hospital’s previous position in the Hospital Report, and pointed out that the requested detention terms would not be very different from those of a conditional discharge.
Findings and Conclusions of the Board
- At the hearing, the hospital's position was that Mr. Sahed presents a significant threat to the safety of the public, in a reversal of its Hospital Report recommendation. While Dr. Chan had initially assessed Mr. Sahed as no longer presenting a significant threat, he reconsidered the risk assessment and supported the hospital position. We accept Dr. Chan's evidence, both in his initial assessment of Mr. Sahed's current clinical progress, focused on this past year in hospital alone, and in his reassessment at the hearing incorporating the broader question of the risk presented by Mr. Sahed in the community and the necessary disposition at this time.
Significant Threat to the Safety of the Public
On the threshold issue, the evidence amply supports a finding of significant threat to the safety of the public at this time.
The term “significant threat” is defined in s. 672.5401 of the Criminal Code as “a risk of serious physical or psychological harm to a member of the public … resulting from conduct that is criminal in nature but not necessarily violent.” A finding of significant threat must be guided by the principles established by the Supreme Court of Canada in Winko, 2 S.C.R. 625, as applied and elaborated in many judicial decisions since then. To state this jurisprudence in a nutshell: The finding cannot be speculative; it must be based on positive findings, supported by the evidence, that both the risk a person would engage in criminal conduct is a “real” risk, and this conduct would cause harm that is “serious”. Both findings are required: Neither a miniscule risk of grave harm, nor a high risk of trivial harm, is sufficient to find a real threat of serious harm.
On this issue, noted first is the evidence of Mr. Sahed's clinical progress this year alone, followed by the contextual evidence supporting a positive finding of significant threat at this time.
Dr. Chan's initial risk assessment was focused on the major positive turn-around Mr. Sahed made this past year in hospital: In December 2023, he began medication treatment and agreed to an LAI formulation, which he continues to take. Since then, he appears to have made a significant shift. He has progressed even more successfully than anticipated. His medication is managing his illness effectively, with no side effect problems, and he says he feels better on it and very happy with it. Mr. Sahed has been developing insight into his risk, the toll taken by his criminal offences, and his need for medication life-long to prevent relapses into mania. There has been no cannabis use concern, and never any concern about interpersonal assaultive behaviour.
Dr. Chan strongly contrasted Mr. Sahed's very good clinical presentation this year from the many years before, including in 2023 in hospital, when he adamantly rejected medication and passionately argued for his own control. Now, Dr. Chan's evidence is, all the passion and argument has eased off. He is less prone to push back against Dr. Chan. He has no problems at all with his medication, which he agrees is helping him. He is doing fine, with not one bit of relapse seen this past year. He has "moved along since 2017."
Also in the past year, Dr. Chan came to realize that Mr. Sahed's passion and arguments against medication and the Board's control were in fact early symptoms of his relapse into mania. This was not recognized before, with the result that no steps were taken under the Mental Health Act, when in hindsight he had been in such a state and, for example, had refused to return to hospital in 2017 or left hospital against medical advice in July 2023, or remained in this state in hospital in December 2023, at the time of his last Board hearing. This diagnostic insight should lead to better management of his relapse risk going forward, although it might be challenging for Mr. Sahed, and for a psychiatrist who does not know him, to recognize these low-grade symptoms of his emerging mania. We note that his mother seems able to recognize them.
Turning to the significant threat issue, at the hearing Dr. Chan reassessed Mr. Sahed as presenting a significant threat to the safety of the public, based on the recent changes in his risk not having been demonstrated in the community – where they have always arisen – outside the securely structured and supervised hospital setting of this past year. We accept and agree with Dr. Chan's reassessment, which is entirely realistic and well supported by the evidence. The limited basis of this year in detention in hospital would be inadequate for determining if there is a real risk that Mr. Sahed will again engage in seriously harmful criminal conduct in the community.
In giving his reassessment, Dr. Chan expressly took into account the Psychological Risk Assessment Report provided by Dr. Rose, a thorough assessment which Dr. Chan noted to be more broadly focused and detailed, than his narrower clinical assessment of the past year alone, in considering Mr. Sahed's full risk history in the community.
The concerns in Mr. Sahed's risk history can be seen, on the evidence, to be three-fold.
First, the risk factors are multiple and serious. They include the nature of his bipolar illness, with characteristic cycles of mania and, most crucially, Mr. Sahed's refusing or stopping medication treatment recommended to manage these cycles (which he is considered capable of deciding); the relapses in his bipolar illness into phases of mania, with serious symptoms including psychosis; his resulting loss of what insight he had into his illness, risk, and need for medication, and his cannabis use which exacerbates his symptoms.
Second, the pattern in his risk history, with a number of repetitions of these risk factors, has been both longstanding and recent; as Dr. Chan agreed in giving his evidence, Mr. Sah ed has a "reasonably long-lasting pattern of dangerous driving and risk." It has recurred since he was about nineteen or twenty years old, in his first index offences in 2009, until well into his adulthood, at age thirty-four in his most recent dangerous driving charges in July 2023.
To note in this risk history, in highlights: Concern about Mr. Sahed's poor medication management was noted in 2013, in Quebec. His February 2016 dangerous driving charges on CN railway involved his relapse into mania and apparent cannabis use; his March 2016 index offences came soon after, on his being bailed and returned home. In 2017, the same risk factors led quickly to his disconnecting from hospital and Board, dangerous offences, and custodial sentence served in 2018. In 2020, after a relapse and suspected cannabis use, he then improved when hospitalized and receiving medication. He stopped medication at some point during the next two years back in the community. After his 2023 arrest came the reckless driving charges in Marathon, Ontario, on June 6, 2023, his return by police to hospital, and his leaving five days later against medical advice. In the community again, he stopped taking his medication, there were property-related charges within days, and his mental state deteriorated. On July 17, 2023, came his most recent dangerous driving charges in Valleyfield, Quebec. On August 2, 2023, he stole his mother's car to drive to Vancouver; was arrested in northern Ontario on property charges, with cannabis in his possession, and was returned to hospital on August 5, 2023, under a Board Warrant of Arrest.
At the time of his previous Board hearing in December 2023, this risk history pattern – of relapse in his untreated illness, cannabis use, and loss of insight, leading to dangerous criminal conduct – was recent and clear, having recurred in June and July 2023, not long before his final rearrest. This was determinative of his current detention disposition, with cannabis, driving, and weapons prohibitions, local community passes, and a community living provision.
Third, it is when living in the community that Mr. Sahed's risk has materialized and led to criminal conduct, and not when he has been detained in hospital or closely supervised under a Board detention order.
This is clear from his risk history. As also elaborated in Dr. Rose's Report, his history includes instances when he relapsed and engaged in serious criminal conduct in the community, after he appeared to be stable and doing well, with similarities to his circumstances at this time. For example, in 2017 – after well over a year of stability under his May 2016 detention order in hospital and then in the community; having completed a course of CBT treatment, with a relapse prevention plan in place, and showing insight into his symptoms, index offences, and risks; and was conditionally discharged in June 2017 – by the fall of 2017, he had moved to Montreal, resumed cannabis use, begun to relapse, refused to return to hospital for assessment, and committed the criminal offences within a month.
In another and more recent example, there were about two years or more of no reported criminal conduct – from the time he stopped his medication after being stabilized on it in hospital in 2020 – until his criminal charges in June 2023, followed by his leaving hospital AMA, stopping his medication, his further serious charges in July 2023, and cannabis possession two weeks later. As this example shows, his history also includes instances when he was seen to improve on medication, such as in his 2020 hospitalization after an episode of mania.
Given this notable history of his heightened serious risk when in the community, it is essential that his progress and the changes in his risk factors be tested and demonstrated in the community. It would be unrealistic to assume, with this history, that Mr. Sahed could simply carry over his recent major changes in hospital into the community and, on his own, manage his risks in the face of the numerous likely challenges for him there. He will naturally need time and practice in responding to the inevitable challenges in the community, with the close oversight and guidance of his forensic treatment team while he does that.
This has not yet been done. Mr. Sahed made some use of his community privileges this year. Dr. Chan testified that he did very well when he used them, and respected all the conditions of his passes, with no substance use or other concerns. Mr. Sahed elaborated that he went out two or three times a week for four or five hours on his six-hour passes, to the gym, library, and coffee shop, and had substance use tests every three weeks, and never broke a rule or made a mistake.
However, regrettably, this community engagement was not as full as it could and needs to be, in order for Mr. Sahed to realistically test out and demonstrate his ability to manage his risk on his own in the community. The shortfall in his community experience was due in good part to the lack of ODSP funding caused by the various delays in processing his application. This delayed the steps to put a community residence in place and to prepare, guide, and oversee Mr. Sahed in his transition to community living there.
Mr. Sahed explained that the lack of funding also prevented him from engaging more in the community, and Dr. Chan did not doubt his explanation for this part of the problem. However, his poor community engagement was also due in part to his own lack of initiative and commitment. This aspect of the problem was outlined in Dr. Rose's Report, and addressed by Dr. Chan at this hearing. Mr. Sahed apparently received funding for the gym and a bus pass, until October 2024, and some family financial support for at least going out for a coffee. It disappointed Dr. Chan that he had not, for example, made an effort to go out for walks. Rather than fully using his community passes, Mr. Sahed spent a lot of time in gaming and other computer pastimes in hospital, and sleeping a great deal (with no health reason for that), including through his pre-hearing conference. We find on the evidence that Mr. Sahed could have engaged more fully activities demonstrating his stability in the community, while awaiting the ODSP funding decision.
In the result, the delays in Mr. Sahed's community engagement and steps to community living make these still early days in his being able to demonstrate that his progress this past year will translate into stable positive changes in his risks, which remain current concerns, when he is in the community.
Based on the whole of the evidence, we find there is a real risk that, without hospital oversight under the jurisdiction of the Board at this time, Mr. Sahed would not be able to manage his reoffence risks on his own, and there is a real risk that the following scenario would unfold again: he would (1) stop taking recommended medication, which is crucial for his stability and risk management, and avoid other treatment support and fall away from mental health care, forensic or non-forensic; (2) relapse into a phase of mania, with serious symptoms including psychosis; (3) lose what insight he had into his illness, symptoms, need for ongoing medication, and the risk of cannabis use for him; (4) use cannabis, exacerbating his symptoms; (5) avoid restrictions on his independence, including by his surety or by police; (7) be unable to establish and maintain a safe and stable life in the community, and (8) engage in seriously harmful criminal conduct towards a member of the public, similar to the extremely dangerous driving in his index offences and other criminal offences and charges, including in 2016, 2017, and 2023.
The seriousness of the harm is obvious. It is potentially catastrophic, Dr. Chan agreed. It has put not only Mr. Sahed but others who happen to be in his vicinity – including police, children, construction workers, and other drivers and passengers – at real risk of grave or fatal injury, with little chance to save themselves. To properly protect the safety of the public requires Mr. Sahed's oversight under the Board’s jurisdiction at this time.
Disposition for the Year Ahead
On the second issue, we agree that a detention order, with the additional term recommended by the hospital, is the necessary and appropriate disposition for the year ahead.
The need for a detention order, at this point in his rehabilitation and his early steps towards community integration, is clear from Mr. Sahed's risk history, and notably his history when he has been in the community under a conditional discharge, in 2017 and the years after that, and again most recently in 2023. Both times, he broke his disposition conditions. Each time, he either did not return to hospital when requested or he left a voluntary admission against medical advice, not wanting to lose his freedom. Both times, the Mental Health Act was apparently insufficient to return him or keep him in hospital, for assessment, risk management, and potential treatment.
These are still early days in Mr. Sahed's rehabilitation and preparation for community living. It is entirely reasonable that time is needed for him to develop, test, and demonstrate, in the community, the changes he has been making in his risky conduct. His success and ongoing stability, and thus the safety of the public, depend on his progressing well now in the community, under expert guidance and oversight, and benefiting from it.
Mr. Sahed will need well-structured housing and treatment team support as he enters more fully into community activity and life. The hospital will need the authority to return and readmit him expeditiously from the community, under the Warrant of Arrest in a Board detention order, in the event his risk increases, including if there are early signs of his emerging mania or his return to cannabis use. Dr. Chan was firm on this recommendation, and the need for Mr. Sahed to have a structured framework to maintain his stability and to progress in the community now, and this is well supported by the evidence.
With respect to the terms of his new disposition, the current terms relating to driving and substance use prohibitions remain essential. The community living privilege remains essential. The ODSP funding has now come through for Mr. Sahed, and there is no clinical impediment to his moving forward in his placement and transition to approved accommodation in the local community. He will be able to engage in structured community activities and programs. He has referred to training and employment he is interested in pursuing. He will have the opportunity to face challenges and to demonstrate his ability to manage his risks and remain stable, to benefit from rehabilitation and other programs, and to establish a pro-social life in the community and seek the appropriate supports he needs there.
The proposed additional one-week passes with an approved itinerary, extending to Montreal, are also essential to enable Mr. Sahed to demonstrate his readiness to integrate safely and stably into what has been his home community. His mother has shown her strong support for her son, and her understanding of his risk and illness, including his early symptoms of relapse. It is apparent that she, her son, and his forensic treatment team with Dr. Chan, have all been working well together throughout this past year, and in considering steps for the coming year.
The plans for the year ahead will include Mr. Sahed taking further steps to demonstrate that he is able to reliably engage in the community and live stably and well there. As Dr. Chan put it, to demonstrate his readiness for an absolute discharge, there are a lot of variables to consider: the reliability of his medication adherence lifelong, his grasp of his risk of harming others through his dangerous driving, the risk of cannabis use for him, and his ability to develop and maintain insight into all these factors, and to act on that insight. To show he can stay on the path he is on now, and follow it well in the community, Mr. Sahed will need to demonstrate his ability to maintain his improvements made in hospital, and progress further with respect to other necessary changes he has not yet made, and do this with increasing independence and personal responsibility.
Lack of insight – into his illness, symptoms, risk of harm to others, need for medication, and the risk of cannabis use for him – has been a repeated serious risk factor for Mr. Sahed. Losing his insight when he relapses into a phase of mania – including losing it quite quickly, and combining that with cannabis use – is a well-documented risk factor throughout his history. In the HCR-20 results noted in Dr. Rose's Report, his "insight" was indicated to be currently present, but only "possibly or partially" so.
Medication was effective, in 2020 and for some time thereafter, and now since December 2023, in managing his cyclical phases of mania. His very poor medication acceptance was described by Dr. Chan as underlying all his "ups and downs" since his absolute discharge in 2013 in Quebec. He has been adhering to the LAI form of the medicine this past year. It will be crucial that he demonstrate the reliability of his long-term adherence when living in the community.
Mr. Sahed seems to have never yet come to grips with the very serious threat to others of his dangerous driving. Nor has he yet demonstrated that he understands the risk for him of cannabis use: he has historically minimized it and paid only "lip service" to the problem. At the previous Board hearing in 2023, Dr. Chan acknowledged that cannabis use disorder might be considered as a separate diagnosis for Mr. Sahed. His risk of cannabis use in the community, including in his home community of Montreal, is essentially still untested. While cannabis use was once viewed as the trigger of his relapses, prior to this year's diagnostic insight into his early symptoms of emerging mania, there has been no change in the clinical concern respecting its role in exacerbating his symptoms of mania and his loss of insight and treatment adherence.
Other possible risk concerns might be thought worthwhile to consider this year, as a clinical decision for Dr. Chan. Two were raised in Dr. Rose's Report. One relates to Mr. Sahed's apparent unstable life circumstances at the time of various property-related charges (such as break-and-enter and theft, acting in one instance with another person, in order to sleep and eat) as indicating an inability to establish a stable income and pro-social peers and community life. Dr. Chan testified that Mr. Sahed explained these incidents by saying "he needed to survive somehow".
Another possible risk concern raised in Dr. Rose's Report relates to the idea that some of Mr. Sahed's risky behaviour and criminal conduct might reflect aspects of antisocial traits. Those noted include Mr. Sahed's disregard for legal authority (including of police and Board dispositions) and disregard for the safety and lives of others. The extremes he has gone to in dangerous driving (including using a car as a weapon of intimidation against a police officer), in order to prevent being thwarted in his plans and deprived of his personal freedom by arrest or detention, might be seen to go beyond even an analogy to intoxicated driving.
Also noted were Mr. Sahed's minimizing his risks and his actions, being unable to take personal responsibility for them (such as having asserted he did what was required of him even as he cut off contact with the hospital and Ontario forensic system), and overall failing to engage and progress in treatment and risk self-management. These failings have persisted well into his adulthood, as noted above, from the age of about twenty at the time of his first index offences in 2009, to thirty-four at the time of his most recent dangerous driving charges in 2023. This past year in hospital, it appears, he may be learning from his experience and maturing to the point where he is able and motivated to make concrete, lasting changes in his risk pattern.
There was discussion of the use of a "Ulysses Clause", in the course of Mr. Sahed's testimony at the hearing, to protect him from a protracted period of non-medication in the event of a relapse and loss of insight. It will be up to Dr. Chan, and Mr. Sahed and his counsel, to decide whether or not this is worthwhile to consider.
It remains to note the strengths and positive outlook for Mr. Sahed as he moves forward this year. We agree with this aspect of his counsel's submissions at the hearing.
Mr. Sahed has been working well with Dr. Chan and his other treatment team members, and they are clearly supportive of him and optimistic about his future progress. Dr. Chan was a very strong advocate for Mr. Sahed. Dr. Chan highlighted how very well Mr. Sahed has done throughout this past year, in a major positive turn-around from his past history, which exceeded even the treatment team's optimistic expectations. Dr. Chan stated that he could not say "with certainty" how Mr. Sahed will do, but certainty is not expected; it speaks loudly that Dr. Chan expressed "every confidence" that Mr. Sahed has now learned from his experience, and will be able to continue his progress when he has moved into the community. Dr. Rose, while of the strong view that his progress must be demonstrated in the community, agreed in her Report that Mr. Sahed has done well in important respects this past year.
In addition, while Mr. Sahed has remained estranged from his brother for some time, he has always had the strong and active support of his mother, who understands his circumstances well, has been there for him with practical assistance, has been his surety, and has been working with his treatment team for the best outcomes for him. When he is in the community, with structure and with guidance from his team, he may well have the opportunity to develop other positive supports in his life.
We agree with the submissions of his counsel respecting Mr. Sahed's very encouraging picture right now, and his potential for a bright future. We wish all the best to Mr. Sahed, and to Dr. Chan and the rest of his treatment team, and his family and other community supports, in their work together in the year ahead.
DATED this 22nd day of May 2025, at the City of Toronto, in the Toronto Region.
Ms. K.A. Connidis
Alternate Chairperson
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Office of the Registrar
Ontario Review Board