Re: Ebenezer Kusi
ORB File No: 6360
Hearing held on: Monday, April 28, 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. C. Finley Members: Dr. P.E. Cook Dr. H. Moulden Mr. B. Garrow Mr. S. Duffy
Parties Appearing:
Accused: Ebenezer Kusi Amicus: Ms. L. Leinveer The person in charge of hospital: Counsel: Ms. A. Marshall Attorney General of Ontario: Counsel: Ms. R. Weinberg
REASONS FOR DISPOSITION
(Dated June 6, 2025)
Introduction
On June 20, 2013, Ebenezer Kusi was found not criminally responsible (“NCR”) on account of mental disorder on charges of assault with a weapon, possession of a weapon for dangerous purpose, and mischief – not exceeding five thousand dollars (x2) all contrary to the Criminal Code, (the “Code”).
Mr. Kusi is detained at the Forensic Service of the Centre for Addiction and Mental Health (“CAMH” and/or the “hospital”) under terms of a Disposition dated May 28, 2024 with discretionary privileges up to and including community living in accommodation approved by the person in charge.
On April 28, 2024, the Board convened a hearing, pursuant to s. 672.81(1) of the Code to conduct the annual review of the current Disposition. Mr. Kusi declined to attend the hearing and was excused pursuant to s. 672.5(10)(a) of the Code. Ms. Leinveer appeared as Amicus.
The issues before the Board are whether Mr. Kusi continues to pose a significant risk to the safety of the public, and if so, what is the necessary and appropriate disposition to manage that risk having regard to the criteria set out in s. 672. 54 of the Code.
Counsel for hospital and for the Attorney General of Ontario jointly submitted that there be no change to Mr. Kusi’s current Disposition. Ms. Leinveer advocated for an absolute discharge.
For the reasons that follow the Board finds that Mr. Kusi continues to pose a significant threat to the safety of the public and that his care should continue on the same terms as his current Disposition.
Evidentiary Record
- Dr. Valoo co-authored the Hospital Report dated, April 4, 2025, exhibit 1, and testified on behalf of the hospital. No further evidence was adduced at the hearing.
Background
Mr. Kusi’s personal and psychiatric history, including the details of his mental disorder and treatment since being found NCR, are described in detail in the Hospital Report. Briefly, Mr. Kusi is 44 years of age, single and has no dependents. He is unemployed and financially supported by Ontario Disability Support Program (ODSP). He is not capable of consenting to psychiatric treatment. Substitute consent is provided by the Office of the Public Guardian and Trustee. He is capable of managing of his financial affairs.
The circumstances of the index offence are reproduced as follows from the Board’s Reasons for Decision of June 20, 2024:
“BACKGROUND
On the following dates of: August 8, August 14, September 18, the residents at the time living at 160 Chalkfarm Drive #1121, Toronto were terrorized by the accused banging and breaking the deadbolt lock, handle and door. On each occasion, the accused made his escape before police arrival. The residents eventually moved out for fear of their safety and the unit had been vacated. Neighbouring residents on the 11th floor were made aware of these incidents.
In December of 2011, a new tenant moved into unit # 1121. On December 10, 2011, the tenant reported a similar occurrence. The accused lives alone in unit # 1021, which is directly below this unit and in his mind believes the female residents in unit # 1121 are having intercourse with him as he would wake up with semen on his underwear and his body aching.
SYNOPSIS
On Saturday December 18, 2011, at 11:10 PM, the accused was banging and damaging with a hammer the dead bolt lock of unit # 1121 at 160 Chalkfarm Drive in the City of Toronto. One of the neighbours observed this and asked what he was doing, the accused replied, “Get away from me” and suddenly focused his attention on the victim. The accused charged the victim with the hammer claw side up and violently swung at him numerous times. This commotion alerted other neighbours who came to the aid of the victim and held the accused down until police arrival.
Police arrived on scene and arrested the accused. During a cursory search, an 8-inch blade kitchen knife was retrieved from his waistband. The accused was transported to 31 Division where he was charged accordingly and held pending a show cause hearing.
The victim suffered numerous skin breaking cuts from the hammer claw to his chin, cheeks, neck, chest and both hands, fingers, and arms. The victim is seeking own medical attention as well as to receive a tetanus shot.
Overall estimated damages to the door/lock/handle on five different occasions: $600.00.”
Mr. Kusi suffers from chronic ultra-treatment resistant schizophrenia, characterized by paranoid delusions varying in severity and intensity and exacerbated by cannabis use. He is treated with olanzapine which he takes orally with supervision.
Mr. Kusi has been under the Board’s jurisdiction since 2013. At the time of his initial hearing he was living in the community, and was permitted to continue doing so under a detention order. He received a conditional discharge in August 2014 and lived in the community until February 2017, when concerns developed over his mental status marked by an increase in the intensity of his paranoid delusions about women in general and his landlady in particular. An early Board was convened in March 2017 the conditional discharge was rescinded, and a detention order with community living privileges was issued.
In February 2018, Mr. Kusi was discharged to Bailey House, which provides staffed and supervised supportive housing to an all-male clientele seven days a week. In 2019 Mr. Kusi received a conditional discharge to reside at Bailey House. He was readmitted to hospital in May 2022 due to substance use and a deterioration in his mental state. In 2023 Mr. Kusi’s Disposition reverted back to a detention order and a substance prohibition clause was added given the negative impact of his use of cannabis and alcohol on his psychotic symptoms.
Course Since Last Annual Review
Mr. Kusi remained an inpatient of the general forensic unit of the hospital for the duration of the reporting period. He had a relatively stable year without any incidents of physical violence or threatening behavior. Mr. Kusi continues to experience residual psychosis in the form of paranoid delusions similar to those at the time of the index offences, albeit of lower intensity. He continued to assent to his oral medication, but stated that he would stop doing so if the dose of his olanzapine was increased.
Mr. Kusi remained extremely guarded about his internal thought experiences, and refused to engage in any detailed discussion about potential psychotic symptoms. Earlier in the reporting period he expressed intermittent paranoia that he was being followed, but this has resolved. He says that he is no longer paranoid about being targeted by women, as was the case last year. Moreover, he developed a positive therapeutic relationship with his female social worker.
Mr. Kusi’s insight into his mental health and the need for treatment remained limited and poor. He wishes to be discharged from the Board’s oversight, but says he would not take his medication if released from its jurisdiction. He maintains that he derives no benefit from his anti-psychotic medication and it plays no role in his treatment. However, he does not recognize his psychotic symptoms, which would undoubtedly increase in the absence of medication.
As reported, Mr. Kusi has previously pointedly stated that he will not be followed by psychiatrists or adhere to the expectations outlined by the Board once he has housing in the community. Furthermore, Mr. Kusi says that he will resume using cannabis, notwithstanding its deleterious impact on his psychotic symptoms and behavior, because its use is legal. To his credit, Mr. Kusi has not had any further instances of substance use since his last annual review. He cooperated with provision of urine drug screens, which were all negative for recreational substances.
Mr. Kusi has attained level 8 indirectly supervised community passes without any issues. However, he has steadfastly declined to participate in any structured programming on CAMH hospital grounds. Similarly, he generally avoids interactions with other patients on the unit, and as noted in the Hospital Report, often responded with hostility when other patients attempted to interact with him. He does not have any relationships with persons outside of the hospital, to the treatment team’s knowledge.
Mr. Kusi says that he will refuse to accept housing in any type of accommodation that will not allow him to cook independently, despite an assessment of his independent living skills in 2023 which raised concerns about his cooking skills and use of a stove in particular. Moreover, he has resisted the team’s efforts to engage him in cooking training, including their offer to submit an application on his behalf to attend the culinary certificate program offered by George Brown College through the Therapeutic Neighborhood program. Mr. Kusi’s attitude has created significant barriers in the team’s ability to plan for his discharge, although they continue to look for suitable housing vacancies on his behalf and engage him in rehabilitative programming to broaden his options for community-based living.
Dr. Valoo stated that the treatment team unanimously believes that Mr. Kusi presents a significant threat to the safety of the public given his ongoing residual psychotic symptoms and poor insight into his mental illness and treatment needs. Furthermore, he has a history of non-adherence to treatment and follow-up and substance use. Mr. Kusi’s clinical risk factors and risk of re-offending are summarized in the Hospital Report:
“The best predictor of future violence is past history. Mr. Kusi’s history of aggression is primarily a result of symptoms of his major mental illness. His paranoid interpretation led to the index offences. Subsequent incidents of violence/aggression have similarly been related to paranoia in the context of active psychotic symptoms.
Should Mr. Kusi re-offend, it is likely to occur either because of non-compliance with antipsychotic medications, or due an exacerbation of psychotic symptoms (for example due to recreational substance use in spite of treatment with antipsychotic medications). In the context of more severe psychotic symptoms, Mr. Kusi will experience worsening paranoia, and misinterpret the actions of those around him as threatening. He may act on paranoid delusional beliefs in a manner similar to that of the index offence, during which he exhibited behavioural dyscontrol and violence towards others. At present, although he is guarded about his internal experiences, his team suspects that he continues to hold beliefs which mirror those he possessed at the time of the index offences (namely paranoia and possibly also somatic delusions). He is resistant to being discharged to a residence where medications are supervised (suggesting a desire to discontinue his antipsychotic medications), has voiced a desire to resume cannabis use after he is discharged from the hospital, and has expressed an indication to refuse oral treatment if his medications are adjusted, even though this has been recommended by his psychiatrists to optimize his treatment. All of these suggest a high risk of re-offence in the absence of a suitable disposition under the Ontario Review Board.”
- It is also unanimous opinion of the treatment team that the necessary and appropriate and least onerous and restrictive disposition is a continuation of the current Disposition, with the ability to reside in accommodation approved by the hospital. Mr. Kusi has ultra-treatment resistant schizophrenia with ongoing residual symptoms and his mental illness is currently being managed with oral medications. Therefore, future forensic psychiatrist psychiatric patient teams require the ability to closely supervise Mr. Kusi in the community, including to ensure medication compliance. This requires the hospital to have the ability to discharge him to approved housing that provides adequate supports, such as supervised medication administration. It also requires his outpatient team to re-admit him to the hospital if he follows through with his stated intention of disengaging from psychiatric care after discharge. Thus, a detention order is necessary and appropriate, and a conditional discharge would be insufficient to adequately manage his risk. And, as such there is no basis for recommending that Mr. Kusi be discharged absolutely.
Analysis and Conclusions
Having considered all of the evidence and the submissions presented by the parties and Amicus, the Board finds that Mr. Kusi continues to pose a significant threat to the safety of the public and that his care should continue on the same terms as his current Disposition. There is no evidentiary basis upon which we are able to consider the appropriateness of a conditional discharge at this time.
The treatment team is to be commended for their continuing efforts to optimize Mr. Kusi’s treatment and engage him in rehabilitative programming with the goal of transitioning him to community living. We urge Mr. Kusi to co-operate with the team, accept Dr. Valoo’s advice with respect to optimizing his treatment, and to do his part to make their plans for his eventual discharge a reality.
In coming to these conclusions, the Board has considered its responsibility pursuant to s. 672.54 of the Code to make a disposition that is necessary and appropriate in the circumstances, taking in to account the safety of the public, which is the paramount consideration, the mental condition of the accused, his reintegration into society, and his other needs.
DATED this 6th day of June, 2025, at the City of Toronto, in the Region of Toronto.
Mr. B. Garrow Legal Member
Office of the Registrar Ontario Review Board