Ontario Review Board
Re: Joe P. Emmanuele
ORB File No: 7840
Hearing held on: Tuesday, May 13, 2025
Place of hearing: Southwest Centre for Forensic Mental Health Care 401 Sunset Drive, St. Thomas
Pursuant to: Section 672.81(1) of the Criminal Code
Before:
Alternate Chairperson: Mr. M.D. Segal Members: Dr. R. Chandrasena Dr. S. Wiseman Mr. E. Siebenmorgen Ms. R. Chopra
Parties Appearing:
Accused: Joe P. Emmanuele Counsel: Ms. K. Bahmra
The person in charge of hospital: Counsel: Ms. J. Zamprogna
Attorney General of Ontario: Counsel: Mr. D. Rows
REASONS FOR DISPOSITION
(Dated June 4, 2025)
Introduction
Joe P. Emmanuele, age 31, was on January 20, 2021, found not criminally responsible on account of mental disorder on a charge of attempt to commit murder, contrary to the Criminal Code.
On May 13, 2025, Mr. Emmanuele appeared before the Ontario Review Board (the “Board”) for his annual hearing at the Southwest Centre for Forensic Mental Health Care (the “hospital”). As Exhibit 1 was a Hospital Report dated March 20, 2025.
In preliminary positions, all parties advanced that Mr. Emmanuele continued to represent a significant threat to the safety of the public and that the current Disposition should be renewed on the same conditions. By the conclusion of the hearing, the Board agreed.
Index Offence
- The circumstances of the index offence are taken from last year’s Reasons for Disposition as follows:
“At 7:37 on October 17th, 2020, at [address redacted], Fergus, the accused, Joseph Emmanuele, born October 11th, 1993, entered the victim’s bedroom and stabbed her in the back of the head. The victim, Mishell Emmanuele, born [redacted],1961, is the mother of the accused. After stabbing the victim, the accused called 911 and advised that he had to kill his mother and that she is not doing well. The accused was located outside of the house, covered in blood, and placed under arrest.
Injuries: The victim was taken to Groves Memorial Hospital with deep puncture wounds to the rear left of her head and multiple stab wounds to the left side of her head.”
- These are well set out at paragraphs 9 to 17 of last year’s Reasons:
“Mr. Emmanuele is a relatively young man, being 30 (31) years old as of the date of the hearing and 27 at the time of the index offence. He is single and has no dependents. His history and background are described in detail in the Hospital Report, and as the Report is in evidence, this information need not be extensively reviewed here. In brief, he is one of two sons born to his parents, who separated when Mr. Emmanuele was approximately seven years old. His brother, who is older, reportedly also has a major mental illness and resides in a group home. Mr. Emmanuele has lived with his mother all his life, up to the time of the index offence, though has visited with his father. Mr. Emmanuele has no employment history and has been supported by ODSP benefits since the age of 18.
Mr. Emmanuele’s diagnoses are listed as follows in the Hospital Report:
Schizophrenia, multiple episodes, in partial remission; and
Severe Cannabis Use Disorder, in forced remission in a controlled environment.
Mr. Emmanuele has an extensive psychiatric and substance use history, as detailed in the Hospital Report. He began to use cannabis in Grade 9. He started to show symptoms at age 14 and left school in Grade 10. He later tried to resume, earned several credits, but ultimately left again.
Mr. Emmanuele has a limited criminal history, having been conditionally discharged on a single count of assault. In addition to this limited record, Mr. Emmanuele has a significant history of violence and antisocial behaviour that spans approximately 13 years prior to the index offence. Many of his psychiatric hospital/medical admissions were due to his violent and aggressive behaviour. That behaviour has included: spitting in staff’s face, punching walls, breaking windows, yelling violently and screaming obscenities, making threatening statements, hitting and pushing his mother, damaging property, assaulting a nurse, throwing his crutches across a room, and “trashing” his basement.
At age 15, Mr. Emmanuele was admitted to Brampton Civic Hospital as an involuntary patient after experiencing auditory hallucinations and paranoid thoughts. He was aggressive with staff and had to be secluded. He was in hospital for approximately three weeks. His discharge diagnosis was psychosis not otherwise specified, with a differential diagnosis of schizophreniform disorder and schizophrenia.
The Hospital Report indicates that Mr. Emmanuele was being followed in the community by an ACT team by at least the first half of 2011, as in June of that year he was brought to hospital by an ACT worker after breaking a window in the ACT office. He reportedly was experiencing hallucinations. There were increasing reports by his mother of assaultive and threatening behaviour towards her. Mr. Emmanuele also assaulted a staff worker at a respite home, and a nurse during one of his hospital admissions that year. He continued to experience hallucinations and was acting on them, but there was also discussion during this period about there being a volitional component to his aggression.
There were very few psychiatric admissions between 2012 and 2020 (the year of the index offence), with one in each of 2015 and 2016. Mr. Emmanuele was reportedly agitated, threatening and aggressive (in the form of property destruction) prior to each admission. The Hospital Report contains little information as to his behaviour and course of treatment in the community (if any) during this eight-year interval. In 2020, there is an indication that he was being followed by an ACT team in the community of Fergus, but it is not clear when this relationship began. His mother reported that Mr. Emmanuele spent his days “drinking coffee, smoking cigarettes and panhandling.” She reported that he panhandles “all day and night” and was banned from several establishments due to customer harassment.
Mr. Emmanuele’s cannabis use reportedly increased in 2020, particularly in the summer. He also had six reported hospital visits and/or admissions between June 4 and October 7. He spent prolonged periods at Homewood Health Centre, with briefer periods at other hospitals or in the community. After spending most of July and all of August of 2020 at Homewood, he was transferred for further stabilization to Grand River Hospital on September 7 and remained there until his discharge on October 7. He presented with hallucinations, paranoid delusional ideation concerning his mother, his psychiatrist, police, and his medications. He was agitated, not sleeping well, aggressive and increasingly threatening toward his mother, and while in hospital in August, became aggressive toward other patients.
Mr. Emmanuele was seen by his ACT worker and a new doctor on October 9, 2020, following his discharge from hospital two days earlier. Mr. Emmanuele reported that he was doing well since his discharge and felt that he had improved. He had quit smoking while in hospital and had quit using cannabis. He reported getting along well with his mother and had no concerns. He reported being compliant with his medications and feeling that they were helpful. His diagnoses were described as “schizoaffective disorder, bipolar type, multiple episodes currently in partial remission – no acute safety issues; cannabis use disorder – in early remission; tobacco use disorder, in early remission.” He was to follow-up with psychiatry in 3 months. The index offence occurred on October 17, eight days later.”
Evidence at Hearing
Dr. A. Malka, the patient’s psychiatrist, testified. Last year Mr. Emmanuele was noted as having a general anxiety disorder, but it is not listed this year. This is so, the doctor explained, because the patient is guarded, so it is difficult to make that diagnosis.
Dr. Malka noted that Mr. Emmanuele’s mental state has fluctuated this year. Recently, Mr. Emmanuele contracted pneumonia which caused clozapine levels to be off a bit, but they have now returned to therapeutic levels. Mr. Emmanuele suffers from hallucinations which can be quite debilitating for him. They are derogatory.
Mr. Emmanuele requires assistance in coping when distressed although he is good about coming to staff for help. Mr. Emmanuele sometimes takes PRNs when this happens.
Mr. Emmanuele’s insight for mental health is a work in progress. He has good insight regarding having a mental disorder and the requirement for medications. He does not like talking about his symptoms. If he knows that staff are pursuing those areas he will clam up.
Mr. Emmanuele’s active symptoms are an obstacle to being involved in programming.
Clozapine is still the best option for the patient. It has not eradicated the positive symptoms, including command hallucinations that were operative at the time of the index offence, but it has decreased the patient’s aggression. There have been no incidents of aggression in the last year.
Mr. Emmanuele still requires cognitive and psychological testing.
Mr. Emmanuele has a long history of cannabis consumption. Cannabis certainly makes his mental disorder and aggression worse. He has not yet engaged in substance use treatment. It continues to make sense to leave open the possibility of an off-site residential treatment program for substances.
The risk analysis in the Hospital Report was agreed with by the doctor. The re-offense scenario would see the patient leave care, start using cannabis and stop taking his medications, resulting in the circumstances that would make aggression and violence appear.
Mr. Emmanuele has a complex relationship with his mother, the victim of the index offences, although has had recent contact with her. There have been some staff-accompanied visits this past year that went well. Family counseling would be recommended at some stage. His mother could benefit from psychoeducation. His mother lives some distance away from the hospital, so current contact is primarily by phone. Mr. Emmanuele represents a moderate risk of violent re-offending if he remains on a detention order in hospital. His risk would increase to high if his liberties were increased.
Mr. Emmanuele has level 3 privileges which enable for him to be on hospital grounds up to three times a day. Mr. Emmanuele is friendly, often greeting people in the halls, and can be forthcoming, depending on how well he knows the person.
In the next year neuropsychological cognitive testing and more involvement in programs is recommended. Mr. Emmanuele is learning to play the guitar.
Analysis
- The Board had before it a joint submission which was sound. Mr. Emmanuele has a long history of substance abuse. Mr. Emmanuele is still symptomatic with auditory and visual hallucinations. They can be quite distressing. Mr. Emmanuele has been doing better of late, but more work needs to be done including on neurocognitive psychological testing and working with the patient to involve him in programming. The panel concluded that based on all the evidence the patient continues to present a significant threat to the safety of the public. Mr. Emmanuele has certain strengths including his friendly demeanor. We wish Mr. Emmanuele well in the upcoming year.
DATED this 4th day of June 2025, at the City of Toronto, in the Region of Toronto.
Mr. M.D. Segal Alternate Chairperson
Office of the Registrar Ontario Review Board