Ontario Review Board
Re: Muhsin Hassan
ORB File No: 8660
Hearing held on: Friday, June 6, 2025
Place of hearing: Centre for Addiction and Mental Health 1001 Queen Street West, Toronto
Pursuant to: Section 672.47(1) of the Criminal Code
Before: Alternate Chairperson: Ms. C. Fromstein Members: Dr. G.A. Chaimowitz Dr. H. Moulden Mr. M.D. Segal Mr. J. Cyr
Parties Appearing:
Accused: Muhsin Hassan Counsel: Ms. M. Perez
The Person in charge of Hospital: Counsel: Ms. A. Marshall
Attorney General of Ontario: Counsel: Ms. V. Culp
REASONS FOR DISPOSITION
(Dated July 18, 2025)
Introduction
On May 27, 2024, Mr. Muhsin Hassan was found not criminally responsible on the charge of assault, contrary to the Criminal Code. His initial hearing before the Review Board took place on June 6, 2025. In the interim, Mr. Hassan has been residing in the community under the terms of an undertaking. His initial hearing was adjourned on March 14, 2025 when he failed to attend. At the time of the court proceedings on May 27, 2024, the presiding Justice did not conduct a disposition hearing and no disposition was rendered. He rather remanded Mr. Hassan to the Review Board for an initial hearing and disposition to be held as soon as practicable or within 45 days of the verdict.
On June 6, 2025, a panel of the Review Board convened at CAMH to conduct Mr. Hassan’s initial hearing. Ms. Marshall appeared as counsel for the hospital; Ms. Culp as counsel for the Crown. Mr. Hassan was present and represented by his counsel, Ms. Perez. Also in attendance at the hearing were Mr. Hassan’s mother, sister and aunt in his support.
At the outset of the hearing, the parties were canvassed as to their initial positions. Ms. Marshall indicated that the hospital is seeking a finding that Mr. Hassan is a significant threat to the safety of the public and that the necessary and appropriate disposition is a detention order at the Forensic Service of CAMH with privileges up to and including to live in the community in approved accommodation. The hospital seeks that the detention order contains privileges up to living in approved accommodation in the community, reporting no less than weekly, abstinence from substance use and substance monitoring and a weapons prohibition. Ms. Culp indicated that the Crown is likely to support that position but wished first to hear the evidence. Ms. Perez indicated that Mr. Hassan seeks an absolute discharge.
The evidence at the hearing was comprised of the following exhibits:
i) Disposition Hearing Outcome ii) CPIC iii) Local Report iv) Synopsis v) CAMH letter, June 17, 2021 vi) CAMH letter, June 22, 2021 vii) Letter from Shannon Fynn viii) Information ix) NCR Report, June 2021 authored by Dr. Benassi x) Hospital Report, March 2025
Index Offence
- The facts of the index offence are set out in the Synopsis, Exhibit 4, as follows:
“On March 21, 2020, the complainant, Nurta Jama, called police regarding Mr. Hassan and the victim, Ms. Amina Mohamed Adenali, stating that the victim reported being kicked in the head. They were at Sheridan Mall in Mississauga, Ontario. When the police arrived, the victim reported that Mr. Hassan had kicked her in the head. She had sustained bruising to her forehead, right side of her head, bloodshot eyes and cut to her nose. She had additional injuries of pain in her right ankle and right butt cheek. She was assessed by paramedics and transferred to Credit Valley Hospital for further evaluation. The victim had reported that Mr. Hassan accused her of being a demon while he was kicking her and would not stop until she told him her name.
Mr. Hassan was arrested at 17:59 hour on March 21, 2020 and transported to Credit Valley Hospital Emergency Department for further assessment. He was assessed by Dr. Clark at 19:37 hour and subsequently placed on a Form 1 under the Mental Health Act.”
Background Information
Mr. Hassan is currently 28 years of age, born March 17, 1997. The details of his background are set out in the hospital report dated February 28, 2025 which can be referred to. Briefly summarized, Mr. Hassan was raised in a stable family background and did well at school. He achieved a high school diploma. Mr. Hassan has three younger siblings, all of whom are currently residing at the family home where he also resides.
The index offence, unusually, took place years before this initial disposition hearing, in March 2020. There was an extensive gap in time before the finding of NCR in 2024. Mr. Hassan had no psychiatric history prior to the index offence in March 2020. He was admitted to Credit Valley Hospital on March 21, 2020 after the index offence. He required a locked unit for the initial part of his admission with his mood described as volatile and irritable. He improved on medication and was discharged to the care of his parents with a diagnosis of substance induced psychotic disorder (cannabis) and a differential diagnosis of an underlying primary psychotic disorder.
Mr. Hassan was next admitted to hospital on August 28, 2022 where he remained until September 21. He had been brought to the hospital on a Form 2 issued by his mother, who had concerns about his decompensated psychotic symptoms in the context of medication non-adherence. In the course of the involuntary admission he was trialled on risperidone but there were concerns with compliance, even in hospital. He was then placed on an injectable medication and showed substantial improvement. He did not have any psychotic symptoms at the time of his discharge on September 21, 2022. He was referred to Dr. Chung in the Psychosis Program, Mississauga Hospital, for ongoing psychiatric follow-up. He attended only the initial appointments and thereafter failed to show up for each re-scheduled meeting. He also failed to attend for his long-acting injectable (LAI) antipsychotic medication following his discharge from hospital.
Mr. Hassan was next brought to hospital on a Form 2 by the police on May 26, 2023. His mother had the Form 2 issued due to concerns about decompensated symptoms of his schizophrenia. He was deemed incapable of consenting to treatment for psychiatric care and his mother became his substitute decision maker (SDM). He contested both findings before the Consent and Capacity Board (CCB) and the CCB upheld the findings. He received treatment on antipsychotic medication. There was clear improvement. A community treatment order (CTO) was initiated. At the time of discharge on June 20, 2023, there was a complete remission of psychotic symptoms but Mr. Hassan continued to have poor to no insight. His discharge diagnosis was schizophrenia.
After discharge, Mr. Hassan was largely noncompliant with treatment. The clinical team had to issue a Form 47 to bring him to hospital to receive his injectable medications. He refused to attend psychiatric appointments with Dr. Chung and missed his depot injection. Between July 2023 to October 2024, he attended two appointments only to receive his LAI depot voluntarily without reliance on the CTO. Since October 2024, Mr. Hassan began complying with the CTO and attended his monthly appointments with Dr. Chung with the assistance of his mother accompanying him. He did not exhibit any acute symptoms of psychosis while adherent to treatment. The hospital report noted he had received his last injection on February 11, 2025.
Mr. Hassan started smoking cannabis in grade 11 and became a daily user when he was 21 years of age. He last used cannabis prior to his index offence in March 2020.
With respect to risk, the hospital report sets out that Mr. Hassan is possibly experiencing ongoing symptoms of his major mental disorder, especially negative symptoms and lack of insight. There has been some recent improvement in his adherence to treatment plans, but it remains unknown if he will continue to cooperate or revert back to past behaviours. It is noted that despite being under the auspices of a CTO, he has continued to avoid and refuse treatment requiring police apprehension in the past to bring him to hospital.
The hospital report summarizes his risk as follows:
“Summary of Risk Assessment
Mr. Hassan's history of criminal and violent behavior is limited to the index offence, and he has no significant history of antisocial behavior or violent attitudes. The primary historical and dynamic risk factors for future violence relate to his major mental illness, characterized by delusions, behavioral disorganization, and affective instability. This risk is further exacerbated by persistent treatment non-compliance and a history of cannabis abuse.
Over the past year, Mr. Hassan has struggled with adhering to psychiatric treatment despite being under a Community Treatment Order (CTO). He has required repeated police apprehensions to ensure compliance with treatment. His insight into his mental condition, the role of psychiatric treatment and his risk of recidivism remains limited.
Overall, based on the above risk factors and risk assessment scores, Mr. Hassan’s risk for future violence is opined to be moderate. He has a significant risk of psychotic relapse absent close supervision and structure.”
Evidence at Hearing
Dr. Benassi, who authored the NCR and hospital reports, testified. He updated the information to note that on May 8, Dr. Chung renewed the CTO order. His mother remains as Mr. Hassan’s SDM. Mr. Hassan appealed the CTO order so the Consent and Capacity Board (CCB) will be reviewing this. Mr. Hassan is now attending for his injections but he has missed almost all of his appointments intentionally with Dr. Chung. Dr. Benassi noted that Dr. Chung has gone above and beyond to assist Mr. Hassan, working with Mr. Hassan’s mother and he has made virtual calls so that he could complete the paperwork necessary for the renewal of the CTO. Mr. Hassan has acknowledged that he has avoided the doctor for the purpose of his being unable to do the paperwork that was necessary. Mr. Hassan continues to show a lack of insight indicating that he does not have a mental health issue and he does not acknowledge any symptoms of that illness or the role of treatment. In Dr. Benassi’s view, if not for the CTO Mr. Hassan would stop taking medication, without consequences in his view. It is only since October 2024, with the support of his family, that Mr. Hassan has attended the depot clinic. Even though the CTO has been helpful as an external structure to medication compliance, Mr. Hassan is not consistently monitored nor seen by a professional. He is actively appealing the legal structure of the CTO which must be renewed every six months, at which time persons can appeal.
Dr. Benassi testified that the CTO can be an effective tool but in Mr. Hassan’s case there are concerns regarding its ongoing viability. He questions if there to be a change in Mr. Hassan’s doctor from Dr. Chung, whether they would be able to put out the effort that Dr. Chung has into obtaining the renewal for someone who is unwilling. Dr. Benassi testified that the Mental Health Act is not sufficient to manage Mr. Hassan’s risk. Based on a CTO, a Form 47 could be issued to bring him to an emergency department. However, that would not be to CAMH. At that time, it would depend which doctor is on call to decide if Mr. Hassan is certifiable on a Form 1. He could meet the Box B criteria because he is incapable. However, if a longer admission was felt to be necessary, that could only take place by reliance on a Mental Health Act Form 3. That would depend on the attending doctor who might not be a forensic psychiatrist and might make a different decision. Dr. Benassi testified that if Mr. Hassan were not compliant with his medications, it is his position that he would decompensate and that would lead to violence.
At the time of Mr. Hassan’s first episode of psychosis he showed paranoid and religious delusions, behaviour disorganization and agitation. He targeted his cousin who was incorporated into his delusions. He had no prior history of violence or criminal behaviour. His violent behaviour was driven by his mental illness. That could be seen as well at the time of his admission when he was aggressive and hostile requiring seclusion in the hospital. Dr. Benassi testified that Mr. Hassan poses a real risk to the safety of others when he decompensates. Dr. Benassi believes that future violence is likely, as it was at the time of the index offence in 2020. It would be anticipated that there would be an intensification in Mr. Hassan’s delusions, an increase in his disorganization and increased restlessness, all of which would be expected to lead to physical and psychological violence, particularly to someone who is close in vicinity to Mr. Hassan, who would be incorporated into his delusions.
Mr. Hassan’s family is a major support to him. Mr. Hassan’s mother has always been extremely supportive of his treatment and made the efforts to get him into the hospital in the past and to his appointments with the doctor when she is able to. There is concern that Mr. Hassan would seek to change his residence from the family home. If placed under an Ontario Review Board disposition, he would have an outpatient treatment team that would do a home visit and then apply for approval to the hospital with respect to the accommodation if it were found suitable. Dr. Benassi testified that it can be difficult to assess Mr. Hassan or to meet with him. Mr. Hassan did not show up for his ORB assessment; he did not show up for his first ORB hearing. This behaviour reflects what the community psychiatrist (Dr. Chung) experiences. Dr. Benassi indicated that he has yet to get to know Mr. Hassan and what is the next best steps for ongoing treatment. Mr. Hassan is currently on injectable medication, haloperidol, which he receives every four weeks. He has no insight into his mental disorder, the symptoms or the role of treatment. He is incapable to consent to medication. He would not, in Dr. Benassi’s opinion, attend hospital upon request of his treatment providers.
As noted, Mr. Hassan had not been attending to obtain his medications until October 2024. Since that time, he has been attending to get his injections monthly but attends only for the injection and leaves before meeting with his doctor. Under the auspices of the CTO, Mr. Hassan, in the past, had been brought to hospital when he did not show up for his medications. Mr. Hassan wished to avoid further apprehension by the police and so was externally motivated by the CTO to attend later appointments. However, he is challenging the CTO. It requires a lot of administrative work to maintain a CTO. Dr. Chung has done exceptional work following through but based in part on the administrative tasks for appeals of the CTO, it is a concern whether the CTO will be continued with ongoing appeals. Dr. Benassi indicated that Mr. Hassan has not received any mental health counselling which would be important for him. He is unable to monitor psychotic symptoms because Mr. Hassan is not seen by a doctor. It is Dr. Chung who must complete the paperwork for the CTO and see Mr. Hassan personally to do so. If Mr. Hassan had been able to avoid Dr. Chung, the CTO would have expired.
Mr. Hassan is in the very unusual circumstance of his index offence taking place in March 2020 with the NCR finding four years later. It has now been five years since the commission of the index offence. There were three hospitalizations between April 2020 to April 2022, followed by a three-year period where he might not have been fully compliant with medication. There has been no violence since the time of the index offence and prior to his being in full medication compliance, starting October 2024. The mother is unaware of when he became noncompliant.
The reason for the request that the disposition include an abstinence from cannabis provision is that Mr. Hassan was using cannabis before the index offence. There was some lack of clarity as to when and how much. Mr. Hassan self-reports that he has not used since and his screens, when he has come to the hospital, have been negative. He was, however, using a large amount daily leading up to the time of the index offence and this was at the time of his first episode of psychosis. Marijuana can be a destabilizing factor and remains a significant risk factor that should be monitored. The CTO provision that he must cooperate with routine lab work, including blood work, usually relates to medication screening but not drug screening.
Dr. Benassi was asked whether the CTO would remain in place if Mr. Hassan was also subject to a Review Board disposition. He indicated that, generally, the outpatient team would reach out to the CTO physician and discuss roles and responsibilities going further. They would try to preserve the community hospital relationship if that hospital was agreeable as it is good to preserve a structure that is already there. A CTO in the future could be part of the management plan as the individual progresses towards an absolute discharge. Given that there is a structure in place that is located near to Mr. Hassan’s home and a doctor who knows him, it would be to his benefit if the CTO could be kept in place. However, Dr. Benassi testified that the CTO is not sufficient from a risk management position in the context of a conditional discharge as opposed to a detention order. One is under the Mental Health Act and the other is not. If there was a breach of the CTO, a Form 47 could be issued which would result in Mr. Hassan being taken to a hospital but not necessarily to CAMH. If he were to breach other conditions of a conditional discharge, the police would be called and it could be complicated to have him admitted into hospital. Dr. Benassi indicated that the weapons prohibition is a standard recommendation.
In response to questions, Dr. Benassi testified that he sees Mr. Hassan’s behaviours, including his guardedness and dismissive attitudes, as flowing from his psychotic illness, but it is also a barrier to treatment. Dr. Benassi was asked specifically, in light of the fact that Mr. Hassan has not engaged in violence, other than in the commission of the index offence what Dr. Benassi saw as the foundation of significant threat. Dr. Benassi testified that if Mr. Hassan further decompensated and became delusional again, he expects that he again would be likely to become violent particularly with someone who is in close proximity to him.
Evidence of Sahara Gulleid
Ms. Gulleid, Mr. Hassan’s mother, testified indicating that the index offence took place in a one-week visit by Mr. Hassan to his aunt’s home where he had gone with his mother. Ms. Gulleid indicated that Mr. Hassan has been meeting with his case worker, Shannon, who attends weekly to the house, or they meet her at the mall. Mr. Hassan speaks to Shannon and they get along. Ms. Gulleid noted that the victim of the index offence is currently living in Vancouver.
Between the time of the index offence and the first community treatment order Mr. Hassan took his medication some of the time. It was when he stopped that she took action. He was not taking his medication when she obtained the Form 2. He was also not taking his medication after his hospitalization in 2022. Two other of Mr. Hassan’s siblings are residing at the home, all of whom are adults.
Ms. Gulleid was asked whether she believes that her son has schizophrenia. She indicated that she is not a doctor. She takes him to the doctor and what the doctor says, “we can’t say otherwise”. She noted that she tries her best to have her son attend his appointments and take his medication. In the past he needed the police to take him because he did not want to go. She indicated that that is why she agreed to the CTO. Her son spends most of his time at the family home. He engages in some gymnastic activities there. He reads, uses the computer and helps her go shopping.
Submissions
Ms. Marshall, on behalf of the hospital, submitted that Mr. Hassan represents a significant threat to the safety of the public. On the evidence of the hospital report and Dr. Benassi, Mr. Hassan still meets that threshold. He lacks insight and does not believe that he requires medication. He has evaded his psychiatric appointments and still will not speak to his psychiatrist. He indicated that he was avoiding the community psychiatrist so that the doctor would be unable to renew the CTO. If Mr. Hassan were not on medication, the evidence is that he will decompensate and become psychotic. Violence is then a likely possibility. That happened when he first became psychotic and the evidence of the doctor is that it is a likely possibility in the future if he were to stop his medication and decompensate.
A CTO is not the appropriate risk management measure. This is a system under the Mental Health Act with its goal not to manage risk but to provide for people who are incapable. It is also unknown whether the CTO will be renewed. It expires every six months, and the individual can challenge it every six months. There would be other barriers to its continuation, and it is not appropriate to manage Mr. Hassan’s risk. She noted that Mr. Hassan is new to the treatment team and it remains unknown at this point how to help him develop insight into his illness. He is guarded and does not provide enough information to do a full risk assessment. This is all the more reason that he requires a detention order disposition as that is the least onerous and least restrictive to manage the risk. It is anticipated that it will permit Mr. Hassan to continue to live with his family but it is necessary that the hospital has the ability to bring him into the hospital if required as it is very unlikely that he would attend voluntarily.
Ms. Culp, on behalf of the Crown, supported the hospital’s submissions.
Ms. Perez maintained her position seeking an absolute discharge for Mr. Hassan. She noted that the index offence took place five years ago. Mr. Hassan has been living in the community since that time with three hospitalizations. He has engaged in no violent or threatening behaviours. The one note of his verbal aggression to hospital staff back in 2022 and at the time of the index offence, involved his first interactions with the psychiatric system. Since then and during some periods of time when he was not on medication, regardless of whether he was on treatment or not, he did not engage in violence. She submitted this calls into question the assumption of a re-offence scenario that is more than speculative that he would become violent again if he were to decompensate or even if he had a severe decompensation. He had in the past been able to be brought to hospital on a Form 2, initiated by his mother in 2022. At that time there was no evidence that he was threatening or violent. She submitted that the Board has to make a positive finding of significant risk. Ms. Perez noted that in this situation it involves a person who has had one incident of violent behaviour but who is otherwise not violent even when showing symptoms. Ms. Perez submitted that the civil mental health system has worked to ensure that there is no further violence. The CTO has been renewed three times despite possible administrative hurdles, even in the context of Mr. Hassan’s ability to challenge the CTO before the Consent and Capacity Board. Ms. Perez disagreed that the CTO does not manage risk. She submitted that it is part of the critical care issue to maintain the individual on treatment, issued on the basis that in the absence of treatment that person is at risk to cause serious bodily harm to himself or others of to substantially deteriorate. Ms. Perez indicated that it is sufficient that Mr. Hassan has been recently showing up to receive his injections. Even though he has not met with Dr. Chung, he has been meeting with his case manager who she submitted could assess him. That is part of her function noted in the CTO to monitor his mental state and compliance.
Ms. Perez submitted that if the Board finds that the significant threat threshold is met, then a conditional discharge would be sufficient to manage Mr. Hassan’s risk. As part of that order, the Board could include Mr. Hassan’s residence as a condition, and he provides his consent to a clause that he maintain this residence and to maintain treatment. He would not oppose a condition that he abstain from substances even though she opined that the evidence does not support the necessity for that provision. She noted as well that she does not believe that the weapons prohibition is appropriate but is not strongly opposed to his inclusion.
Analysis and Conclusion
Significant Threat
The Board reviewed the evidence and the submissions before us in consideration of whether significant threat had been established beyond speculation. We recognize that the index offence took place five years previous to this hearing and on the evidence is Mr. Hassan’s only engagement in violent behaviour. He does not have a substance use issue at this time nor display a history of antisocial attitudes. In determining the question of whether Mr. Hassan represents a significant threat of engaging in serious violence in the future, we considered the following issues: he has no insight into his mental disorder or in the role of medication. Mr. Hassan was noncompliant with his medication despite the issuance of the community treatment order. He ultimately began to comply with the order by attending for his depot medications in October 2024 to avoid being again arrested by police and brought to hospital. On the evidence before us, in our view it is likely that the community treatment order will not be able to be continued into the future. It requires extreme diligence on behalf of a doctor to maintain it in light of Mr. Hassan’s appeals of the order. He avoided having any contact with Dr. Chung for the specific reason of trying to deprive Dr. Chung of the ability to do the necessary paperwork. He continues to avoid and not have contact with Dr. Chung even while attending for his injection. It is insufficient that he does have some contact with his community case worker. On the evidence, it is the full expectation that Mr. Hassan would not comply with medication absent the external control on his doing so. Further, the case manager’s observations are not enough to determine Mr. Hassan’s risk to the community.
We recognize that his only engagement in serious violence took place at the time of the index offence. It is not known since that time how often and to what extent he has been noncompliant with medication. Should he become fully noncompliant, for which he is motivated by his complete lack of insight, he will decompensate. Despite his singular violent episode all indications are for future nonadherence to medication and follow-up. This is not a stable presentation where one can predict future violence based on past violent behaviour. The clinical and behavioral indications are of an unengaged ill man whose illness and associated risk behaviours will intensify. His illness will likely progress. It is our view that it is not speculative to say that he would in that context very likely become violent again and pose a serious threat to the safety of the community. This violence is most likely to be directed at someone who is in close proximity to him who gets incorporated into his delusions, similar to the index offence. We note further that because of Mr. Hassan’s unwillingness to engage with a treatment provider there is no information as to his view of the index offence. Based on the evidence before us it is our conclusion that Mr. Hassan does meet the threshold of significant threat to the safety of the public. He has not engaged in violence during the time since the index offence when he has been intermittently off his medication to an unknown extent. It is the link between decompensation in the course of non-adherence and violence that remains.
Necessary and Appropriate Disposition
It is the unanimous view of the Board that the necessary and appropriate disposition is a detention order; that a conditional discharge is insufficient. Mr. Hassan would clearly, on the evidence not attend to hospital voluntarily. The key to his maintaining his mental health is full medication adherence. Even if the conditional discharge included his consent to take medication, it is obvious that Mr. Hassan disregards restrictions placed upon him. A conditional discharge coupled with the community treatment order is in our view also insufficient to manage Mr. Hassan’s risk. We have no confidence that the CTO will remain in place. Further breaches of these orders would permit police to arrest Mr. Hassan but would not result in his being brought necessarily to CAMH and a doctor might not admit Mr. Hassan into hospital and even if Mr. Hassan was admitted to hospital, that admission might not allow for sufficient time to stabilize Mr. Hassan. Significant risk posed by Mr. Hassan can be mitigated effectively only on a detention order disposition.
Mr. Hassan was using cannabis heavily leading up to the index offence and it remains a risk factor. This is so despite his current apparent abstinence from marijuana use. For this reason, we include in the disposition the provision that he abstain from the use of substances and submit urinalysis for testing.
Mr. Hassan has no history of the use of weapons and those were not involved in the index offence. We do not find that the weapons prohibition should be included in the disposition.
We therefore issue a detention order with privileges that include up to community living in approved accommodation, that Mr. Hassan report not less than once per week, that he abstain from cannabis and non-medically prescribed substances and submit random urine samples to assess for same, and that he has no contact with the index offence victim without her revocable consent. We make the latter order recognizing that the victim currently resides in Vancouver but, as a family member, may visit home in the future. There is no evidence in this regard before us.
We make this disposition in consideration of the prime factor of protection of the safety of the public, Mr. Hassan’s mental condition, his reintegration into the community and his other needs.
DATED this 18^th^ day of July, 2025, at the City of Toronto, in the Toronto Region.
Ms. C. Fromstein Alternate Chairperson
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Office of the Registrar Ontario Review Board