Ontario Review Board
Re: Hamza Dhaqane Ahmed
ORB File No: 8141
Hearing held on: Wednesday, April 2, 2025
Place of hearing: Royal Ottawa Mental Health Centre
Pursuant to: Section 672.81(1) of the Criminal Code
Before:
Alternate Chairperson: Ms. C. Finley
Members: Dr. S. Lessard
Dr. S. Wiseman Mr. D. Sandor
Ms. N. Lemieux-McKinnon
Parties Appearing:
Accused: Hamza Dhaqane Ahmed
Counsel: Ms. M. Munsterman
The Person in charge of Hospital: Representative: Dr. R. Linthorst Attorney General of Ontario: Counsel: Ms. M. Dufort
AMENDED REASONS FOR DISPOSITION
(Dated June 11, 2025)
Please see underlined changes to original reasons made June 16, 2025:
Introduction
On September 7, 2022, Hamza Dhaqane Ahmed was found not criminally responsible on account of mental disorder on charges of assault (x4), assault with a weapon (x2), assault peace officers, and two counts of fail to comply, all contrary to the Criminal Code of Canada. She is subject to a disposition of the Ontario Review Board, dated January 12, 2024, discharging her subject to certain terms and conditions, including that she report to the person in charge of the Royal Ottawa Mental Health Centre (hereinafter referred to as “the Hospital”), or his or her designate, not less than once every two weeks.
On April 2, 2025, a panel of the Ontario Review Board convened a hearing at the Hospital to review that disposition pursuant to section 672.81(1) of the Criminal Code. Ms. Ahmed was present for the hearing, represented by her lawyer, Ms. Munsterman. Though arrangements were made for a Somali Arabic interpreter to attend to assist Ms. Ahmed, one did not attend. On Ms. Ahmed’s consent, confirmed with her lawyer, other arrangements were made for a nurse that regularly assists Ms. Ahmed and who speaks her language to provide simultaneous translation over the course of the hearing.
The record for the hearing included the Revised Notice of Hearing, dated January 27, 2025, the most recent disposition mentioned above, dated January 12, 2024, and the Reasons for that Disposition. On the consent of all parties a Hospital Report dated March 28, 2025, was entered into evidence as exhibit 1.
The parties were canvassed for initial positions. Dr. Linthorst, a six-year resident in psychiatry at the Hospital functioning under the supervision of Dr. F. Wood, spoke for the Hospital. He expressed the position that Ms. Ahmed continued to represent a significant threat to the safety of the public as that term has been defined by the Supreme Court of Canada in Winko v. British Columbia (Forensic Psychiatric Institute), 1999 CanLII 694 (SCC), [1999] 2 S.C.R. 625. He also expressed the position that it was necessary and appropriate, having regard to the objectives set out in section
672.54 of the Criminal Code, Ms. Ahmed be subject to a detention disposition, terms and conditions of which would include a provision that she be permitted to reside in the community in accommodations approved by the person in charge at the Hospital.
Both the representative of the Attorney General and counsel for Ms. Ahmed agreed with the Hospital, both with respect to the threshold issue of significant threat and that of disposition. Over the course of the hearing however, issues would arise associated with specific provisions being recommended within the context of a detention order, namely whether it would be appropriate, having regard to the objectives set out in s. 672.54, for Ms. Ahmed to be extended international travel privileges and whether it was necessary and appropriate to impose conditions associated with use of substances, alcohol or other intoxicants.
For the following reasons, the Board accepts that joint submission and finds that Ms. Ahmed continues to represent a significant threat to the safety of the public. It has further concluded that the necessary and appropriate disposition, having regard to the primary objective of assuring the safety of the public, together with the other objectives set out in section 672.54 of the Criminal Code, and applying the principle of minimal intrusion, is that of a detention disposition. It has concluded that the granting of international travel privileges is not in accordance with the 672.54 objectives at this time, but that it is appropriate to exclude any provisions regarding substances from the next disposition.
Evidence at the hearing
The evidence at the hearing came from the Hospital Report mentioned and the live testimony offered by Dr. Linthorst.
Turning first to the Hospital Report, it is cumulative in nature and sets out significant details regarding Ms. Ahmed’s personal and psychiatric history (inclusive of her course while under the jurisdiction of the Ontario Review Board). Ms. Ahmed has no criminal record. It includes a summary of the index offences as set out also in last year’s Reasons for Disposition:
On March 27, 2020, Ms. Ahmed resided at a supported group home, Parklane Residence. She assaulted a resident staff member while holding a butter knife. The staff member feared for her safety and fled to another room. Ms. Ahmed was taken to the Montfort Hospital where she was treated with long-acting injectable medication and later discharged on April 9, 2020. While Ms. Ahmed was determined to be criminally responsible for this offence, the Board has been permitted to include the circumstances in its consideration.
On July 16, 2020, Ms. Ahmed was involved in three separate incidents. At the Ottawa Hospital General Campus that morning she became irate, violent, and aggressive to hospital staff members. She spit in the face of a patient care assistant. She then threw a glass of milk and water at a nurse. Having been told that she would be discharged, when security escorted her outside, she pulled a plastic hand sanitizer dispenser off the wall. Police released her on an undertaking at a location near Walkley Road and Albion Road, by noon hour, at her request.
Shortly after, on July 16, Ms. Ahmed was involved in an altercation with strangers on the street. She began yelling and ran toward a person waiting at a bus stop, trying to spit on this person, who managed to run away. Continuing along the road and while she was watching traffic entering and exiting a Tim Horton’s coffee shop, she began to yell and slam a shopping cart into a vehicle that was leaving the restaurant. The driver got out of the vehicle and removed the shopping cart before calling the police. The responding police officer then received another call about a disturbance further down Walkley Road and she was arrested and released on an undertaking from the Civic Hospital.
Later on the same afternoon of July 16, Ms. Ahmed was staying at the Shepherds of Good Hope homeless shelter in downtown Ottawa. Arriving by car, she walked directly toward a staff member who did not know her. Ms. Ahmed was carrying a large black shoulder bag. Approaching the victim quickly, she struck the staff member on the left shoulder with the bag. The staff member tried to run away; however, Ms. Ahmed followed her into the building, intending to strike again.
On September 24, 2021, Ms. Ahmed was an inpatient on the psychiatric unit of the Ottawa Hospital – Civic Campus. A hospital employee was there. Ms. Ahmed sat in the “employee only” seating area. She was asked to leave but became upset and told the victim to shut up. Ms. Ahmed threw a cup of hot coffee at the hospital employee, striking her on the lower right of her back. She then threw a tray, flipped a sign, and threw more coffee into the hallway where others were walking by. Security removed her from the premises. She was then arrested by the police who released her on an undertaking to the Queensway-Carleton Hospital.
The next day, September 25, 2021, saw Ms. Ahmed again an impatient on the Psychiatric Unit of the Ottawa Hospital Civic Campus. Staff called security when she began to bang and spit on a glass window. Three security guards were needed to bring her back to her room. Once there, she spat directly onto the victim’s face mask, vest and pants.
Ms. Ahmed was then bound by two undertakings with conditions not to attend the Civic Hospital in Ottawa. She went there on February 4, 2022 in the late evening, complaining of an upset stomach. In the waiting room, she caused a disturbance. She was yelling and hitting the plastic seating partitions and started a verbal argument with another patient. Security escorted her off the property. Ms. Ahmed slipped on the ice when she left the hospital. A special constable with OC Transpo spoke to her. She asked to return to the hospital. Paramedics responded and brought her again to the Civic. Soon after midnight on February 5, 2022, the nurse assessed her in the triage area. Ms. Ahmed told the nurse to shut up and assaulted her by punching her in the face with her left hand while holding a vomit bag. Security members arrested her. Police were called and she was taken to a cell block to be held for a bail hearing.
On February 14 and 17, 2022, while awaiting trial and held in detention at the Ottawa- Carleton Detention Centre, Ms. Ahmed was admitted on a temporary absence pass to the Ottawa General Hospital. There, she was kept in the custody of two OCDC corrections officers.
On February 14, 2022, a corrections officer escorted Ms. Ahmed to the washroom so she could do her morning prayers. Her handcuff was removed from the bar of the bed, and she was then handcuffed to the front and went to the washroom completing her prayers. Returning to her bed she pulled her hand away from the officer who was about to transfer one handcuff to the hospital bar bed. Ms. Ahmed pulled her hand away and dug her right fingernail into the female officer’s left wrist. The officer received numerous scratches, some which were bleeding requiring cleaning and bandaging by a hospital nurse.
On February 17, still in custody at the Ottawa General Hospital, Ms. Ahmed was assisted by the corrections officer with her meal. Pulling away from the officer who had returned Ms. Ahmed to her room to secure her hand, she told the officer, “I will kill you” numerous times. She then spat at the officer twice, hitting the leg of her uniform. The officer tried to gain control of Ms. Ahmed’s arm but was struck in the chest by the patient. Ms. Ahmed dug her nails into the officer’s wrist, causing scratching and breaking of the skin. Once Ms. Ahmed was put under control, nursing staff cleaned the officer’s wounds and bandaged her injuries.
Upon making the September 7, 2022 NCR finding, the court re-released Ms. Ahmed on a bail of recognizance requiring her attendance at the ROMHC. Between September 7 and December 5, 2022, Ms. Ahmed, with intensive support from the ACT Team, lived successfully in her independent apartment while subject to bail terms of release.
The Hospital Report explains that Ms. Ahmed is now 54 years old and was born in Mogadishu, Somalia as the youngest in a family of 14 children. Her father died suddenly of kidney failure when she was 13, but the family otherwise remains intact. The family was however affected by the civil war that broke out in Somalia. Prior to this, Ms. Ahmed was doing well socially and in school. She had good grades, had graduated from high school and was about to start university when her family home was blown up by a bomb. While, fortunately, no one was home at the time, Ms. Ahmed’s sister has recalled that her behaviour changed at that time, leading to some belief in the family that the trauma may have contributed to her mental health problems.
In 1991, when Ms. Ahmed was 21 years old, she fled the country and the widespread sexual violence that was happening over the course of the war there, and moved to Ethiopia, then to Germany, and then to the Netherlands. In 1995, she married a Canadian citizen who sponsored her for permanent residency in Canada. Upon moving to Ottawa, Ms. Ahmed did not live with her husband but rather moved in with some of her siblings who were already living in Ottawa.
Ms. Ahmed’s first hospitalization associated with mental illness took place in 1996 when police were called by her family members who reported that she had been occasionally acting out violently and refusing to leave the home when asked. Following this, Ms. Ahmed lived briefly with a different sister in Montreal before returning to Ottawa. After this, Ms. Ahmed returned to Ethiopia for about a year during which time she divorced her husband. In 2010 she moved to Toronto where she lived in a homeless shelter for a year. Outside of these periods and a brief time in Vancouver, Ms. Ahmed has lived mostly in Ottawa.
In 2014, Ms. Ahmed travelled to Somalia and remarried into a polygamous relationship that ended in divorce when her husband found that he was unable to obtain a passport for travel to Canada. She remains single at this time and has no children. Though relations with her family can be somewhat strained, her main sources of support continue to come from sisters and a brother also live in Ottawa.
Ms. Ahmed is a recipient of support through the Ontario Disability Support Program. She has never been employed.
In terms of Ms. Ahmed’s psychiatric history, her current diagnosis is schizoaffective disorder. Historically she has had problems with paranoid delusions, aggressivity and disorganized thinking. She has, in the past, struggled with noncompliance with recommended antipsychotic medications, including a long-acting injectable antipsychotic. She has experienced longstanding social anxiety. When she has been noncompliant with treatment, she has experienced rapid decompensations of her illness. She has at times decompensated while adherent to treatment. She has displayed patterns of interpersonal hypersensitivity and mood lability even when not experiencing acute mood or psychotic episodes, consistent with cluster B (borderline) personality traits. Since she has come under the jurisdiction of the Ontario Review Board, she has generally exercised insight into her major mental illness and need for medications but has experienced restrictions of liberties and occasional setbacks owing the
rapidly cycling nature of her symptoms. This has necessitated several adjustments to her medications over the years.
Inasmuch as Ms. Ahmed’s hearing has been the subject of adjournments that took it beyond its first scheduled annual review, it is helpful to start the Hospital Report’s update with that prepared for what was to originally be her scheduled hearing on January 7, 2025. Starting at page 33, the Hospital Report indicates that at the outset of January 2023, Ms. Ahmed was living independently in her own apartment but experienced a decompensation in her mental health status that resulted in her admission to the Ottawa Hospital – Civic Campus on January 23, 2023. Her hospitalization continued through to February 2024 where her continued stability led to considerations of group home or long-term care placement. Over the months of meetings with Ms. Ahmed’s family and potential group home and long-term care options, Ms. Ahmed’s major mental illness was relative stable.
In August 2024, Ms. Ahmed began to show more irritability and isolation. Her medication was adjusted, and symptoms of depression appeared to resolve only to re-emerge several weeks later, which the treatment team took as evidence for a rapid cycling mood disorder. Her medication was adjusted again, and Ms. Ahmed became more engaged and active on the unit. She began to attend for physical therapy and used passes appropriately.
Throughout this time, Ms. Ahmed has remained on the unit as a voluntary patient. While discharge planning has repeatedly taken place, it has regularly run into complications as a result of Ms. Ahmed’s expectation that her family will agree with wherever she is discharged to, whereas the family continues to decline available housing options. The Hospital Report explains that Ms. Ahmed has had family members acting as her Power of Attorney and substitute decisions makers for personal care decisions. In this legal context, the family has objected to both long-term care residences and group homes. Culturally, there is a preference with this family not to make decisions unless there is unanimous agreement within the family. Even with regard to recommended antipsychotic medications, the family has been unable to come to unanimity. As a result, her overnight passes with family have been held. Prior overnight passes resulted in medication non-adherence and subsequent deterioration. It is noted in the Hospital Report that, historically, Ms. Ahmed’s decompensations have been extremely rapid.
The Hospital Report acknowledges that Ms. Ahmed has improved clinically over the course of the past review period in terms of management of her mood symptoms, but it notes that she has had some minor fluctuations in her mood while on the Forensic Rehabilitation Unit. Occupational Therapy testing completed on January 25, 2025, showed that she needs assistance with medication supervision, bathing, compression stocking changes, meal preparation and prompting for cleaning and laundry. Mobility is a concern if she needs to navigate stairways. Long-term care appears to be the most suitable option to be explored over the course of the next review period. Opposition from her family, including her brother Yaquub who currently exercises Power of Attorney for her personal care, and who believes she should be in the Hospital for the rest of her life, will likely raise ethical concerns the Hospital will have to consider.
In his oral testimony, Dr. Linthorst relied on the Violence Risk Assessment found at page 39 of the Hospital Report. The methodology and juridical accuracy of the analytical data relied upon in completion of that Assessment were not challenged over the course of the hearing. It indicates that Ms. Ahmed presents as a moderate risk of future violence and specifically notes the risk of aggressive and assaultive behaviour. It notes that while she recognizes that she has a mental illness, she does not believe that she has ever experienced psychosis. Her insight as to the extent of her need for treatment is suboptimal. She continues to experience periodic cycling of her mood symptoms. She no longer has a regular psychiatrist who follows her outside of the Forensic setting. Community mental health supports need to be re-established if the ultimate objective of reintegration into the community is to take place in a manner that also assures the safety of the public. She will need daily living supports that include supervision of her level of compliance with recommended treatment.
Dr. Linthorst said that Ms. Ahmed’s strengths lie in her willingness to work with the treatment team both in and out of cycling mood symptoms. Those symptoms have improved with medication such that, as of the date of the hearing, several months had passed without clear depressive symptoms. He said, however, that she has limited understanding of her psychotic illness and does not believe she suffers from psychotic symptoms. She does not understand that she potentially has a mood disorder requiring medication. He said that next steps include progressing towards appropriate accommodations – likely long-term care – that will meet her needs in light of her level of independent functioning. He confirmed and adopted otherwise the contents and concerns expressed in the Hospital Report.
Dr. Linthorst gave evidence related to Ms. Ahmed’s desire to travel to Mecca and opined that a period of prolonged stability – a six-month to one-year period – would be preferable before this could be approved. He highlighted occupational functioning concerns for such a trip as well as concerns associated with her family’s willingness to support Ms. Ahmed’s compliance with prescribed antipsychotic medications. He confirmed that, even in terms of local travel to Quebec, this would only be approved if there were no concerns with medication compliance. He emphasized the strong opinions of Ms. Ahmed’s family with regard to her treatment. It was clear that the family’s opinions do not align currently with the Hospital’s recommendations for the attaining of the objectives set out in section 672.54 of the Criminal Code. He confirmed that substances have not been a concern for Ms. Ahmed.
Submissions
At the end of the hearing, the parties renewed their joint submission as set forth earlier. All agreed that Ms. Ahmed represented a significant threat to the safety of the public. All agreed that a detention disposition was necessary and appropriate in consideration of the Board’s primary objective, which is the assurance of the safety of the public, and all agreed that such a disposition was likewise necessary to ensure that Ms. Ahmed’s mental health and other needs were met, including the ultimate objective stated in section 672.54 of the Criminal Code, namely her reintegration into the community.
The issue of international travel privileges was specifically addressed by the parties. Counsel for Ms. Ahmed highlighted that this would be incentivizing for her and that any international travel would have to be on an itinerary approved in advance by the Hospital. The representative of the Attorney General disagreed, arguing that extending the privilege at this time was inconsistent with the Board’s primary objective and that it was unlikely that Ms. Ahmed would be able to be approved for such travel over the next review period. She suggested that an early review hearing was a possibility in the event that progress supportive of approved international travel privileges was made.
The Hospital agreed that a provision permitting approved travel could be motivating but acknowledged that Ms. Ahmed had limited insight into her major mental illness and her family has not been supportive of treatment recommendations. The Board was directed to evidence of Ms. Ahmed’s past rapid decompensations that took place within days of stopping medication and led to over 500 days of her remaining in the Hospital to address resurging symptoms. It was noted that, at present, Ms. Ahmed is not on any long-acting injectable antipsychotics.
The parties also addressed substance restrictions as forming part of the ultimate disposition. All agreed that there was no evidence that Ms. Ahmed had struggles with substance use. It was jointly recommended that, in accordance with the principle of minimal intrusion, clauses pertaining to substance use be excluded from the next disposition.
Analysis and conclusion
As stated above, the Board agrees that Ms. Ahmed represents a significant threat to the safety of the public as that term has been explained by the Supreme Court of Canada in Winko. It does not arrive at this determination lightly, even in the context of a helpful joint submission. It has considered whether there is a significant risk both that Ms. Ahmed will commit a serious criminal offence in the absence of a disposition and whether significant physical or psychological harm would flow from that offence.
Ms. Ahmed has a lengthy history of struggles with a major mental illness that contributed to a serious index offence. Her insight into that mental illness remains partial. She does not recognize that she has experienced periods of psychosis. She does not recognize that she likely suffers from a mood disorder that requires medication. She has a history of rapid decompensation when she fails to take medication as prescribed and is reliant on the Hospital for monitoring, prompting, and encouragement to take current medications. In the past, noncompliance with recommended treatment has led to hospitalization in excess of 500 days. It contributed to the emergence of psychotic symptoms that exposed her family and others to assaults and acts of aggression. Ms. Ahmed’s family, which is her primary social support, has not been supportive of her treatment needs in the past. This has led to deterioration of her mental health symptoms. The Violence Risk Assessment included in the Hospital Report considers these factors and concludes that Ms. Ahmed presents a moderate risk of offending by acts of assault and aggression. These factors, together with Ms. Ahmed’s lack of community mental health supports and accommodations that would be suited to the limitations of her occupational fitness, drive the Board’s determination that, without a disposition, Ms. Ahmed
would likely experience stressors such as homelessness and family conflict, cease taking prescribed medications and rapidly decompensate into manic symptoms leading to the types of assaults and violence seen over the course of the index offences.
Turning to the issue of disposition, the Board was met with a joint submission that a detention disposition was necessary and appropriate having regard to the factors set out in section 672.54 of the Criminal Code. The Board agrees. In arriving at this conclusion, the Board considered whether a lesser disposition could assure the safety of the public. This remains the Board’s primary objective. In its estimation, no lesser order could assure the safety of the public where Ms. Ahmed’s major mental illness includes symptoms of rapid cycling in her mood and where she has no community supports in place to manage the risk she presents. If subject to a lesser disposition, there is a real likelihood that Ms. Ahmed would find herself homeless and would not be supported by her family with regard to her need for anti-psychotic medications.
Ms. Ahmed is not on a long-acting injectable, as the family is not unanimously supportive of that form of treatment. Ms. Ahmed requires support from the Hospital in the way of reminders regarding her oral medications. She requires assistance with regard to several aspects of daily living. These latter two points specifically relate to not just the Board’s primary objective, but the other objectives it must consider regarding assuring that Ms. Ahmed’s mental health and other needs are met. This is an important objective that the Board, and the Hospital, must maintain as a matter of statute. It is important as a stand-alone consideration and as a necessary consideration informing the ultimate objective of Ms. Ahmed’s reintegration into the community. At this stage and given Ms. Ahmed’s family’s resistance to recommended long- term care options for housing, as well as recommendations made by the Hospital pertaining to long-acting injectable antipsychotic medications, it is clear that a detention disposition is the only disposition that will empower the Hospital to meaningfully attain to all of the 672.54 objectives set out in the Criminal Code.
Ms. Ahmed does not present with any concerns associated with use of substances. There was no evidence at the hearing supportive of the inclusion of any terms associated with substances, alcohol, or other intoxicants. Accordingly, and having regard to the principle of minimal intrusion and the liberty interests that must be preserved in the context of an NCR accused, such terms will not be ordered.
Finally, the Board considered carefully whether the evidence supported the inclusion of a privilege permitting international travel as approved by the Hospital on an itinerary provided in advance of the travel. There was some evidence that this provision could be motivating for Ms. Ahmed. Travel to Mecca for her is of cultural and spiritual importance. In our view however, the inclusion of such a provision does not accord, at this time, with the objectives set out in section672.54. Ms. Ahmed has a history of noncompliance with treatment when in the community. She is not on a long-acting injectable antipsychotic. Her family, who would be her supports for travel to Mecca, has not ensured medication compliance in the past. This has led to rapid decompensation – within days – for Ms. Ahmed. That decompensation was marked by assaults and acts of aggression directed towards her family and others. Ms. Ahmed would require significant supports from individuals that exercise unified insight and commitment to
her therapeutic and treatment needs, inclusive of recommendations that Ms. Ahmed be treated with a long-acting injectable antipsychotic medication before such travel could be considered appropriate within the rubric of the Board’s primary objective – the assurance of the safety of the public.
While there was concession that such a privilege “could” be motivating for Ms. Ahmed, the evidence did not support the conclusion that it would assure her mental health and other needs. These needs include the formation of community and family supports that will assure that she is able to exercise basic functions associated with living in approved accommodations suited to her needs. They include the formation of community and family supports that are unified in their understanding of the need to assiduously follow treatment recommendations made by a treatment team that is charged with a specific mandate set out in the Criminal Code of Canada. These are important conditions precedent to the granting of international travel privileges. Should these conditions be put into place and tested over the course of the next review period, and should Ms. Ahmed continue her current trajectory, the Hospital has indicated it would request an early review in facilitation of the travel. In our view, it is not possible to assure the safety of the public by granting such a privilege at this time. Furthermore, it is our conclusion that the inclusion of the privilege would not assure that Ms. Ahmed’s mental health and other needs are met, particularly where priority should be given to treatment optimization in an environment that transitions her first to appropriate long-term care accommodations and tests her ability to manage psychotic symptoms in an environment different from that offered by the Hospital’s Forensic Rehabilitation Unit.
As a result, the Board concludes that Ms. Ahmed continues to represent a significant threat to the safety of the public, and that it is necessary and appropriate to order that she be detained with privileges as set out in the Disposition that has been issued.
The Board thanks those who assisted with this hearing and especially thanks Ms. Ahmed’s nurse who stepped in to assist with simultaneous translation. It thanks Ms. Ahmed for her attendance and commends her for her ongoing work with her treatment team and hopes the best for her over the course of the next review period.
DATED this 11th day of June 2025, at the City of Toronto, in the Toronto Region.
Mr. D. Sandor Legal Member
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Office of the Registrar Ontario Review Board