Ontario Review Board
Re: Liban Ahmed Jama
ORB File No: 7327
Hearing held on: Thursday, June 19, 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: Ms. S. Kert
Members: Dr. T. Verny Dr. J.C. Rose Ms. K. Tomaszewski Ms. C. Plyley
Parties Appearing:
Accused: Liban Ahmed Jama Counsel: Ms. K. Bhamra
The person in charge of hospital: Counsel: Ms. J. Zamprogna
Attorney General of Ontario: Counsel: Mr. D. Rows
REASONS FOR DISPOSITION
(Dated July 22, 2025)
Introduction
On April 3, 2018, Mr. Liban Ahmed Jama was found not criminally responsible on account of mental disorder on charges of failing to comply with probation and criminal harassment, all contrary to the Criminal Code of Canada. He is currently subject to a disposition dated July 5, 2024, detaining him at the Southwest Centre for Forensic Mental Health Care, St. Joseph's Health Care London (the ‘hospital’) with privileges up to and including to live in the community of Southwestern Ontario in accommodation approved by the person in charge.
On June 19, 2025, a panel of the Board convened at the hospital to review that disposition. Mr. Jama’s counsel, Ms. Bhamra, advised at the outset that her client did not wish to attend the hearing because Board hearings cause him stress. He had provided Ms. Bhamra with instructions to proceed in his absence, and with his position. Ms. Zamprogna represented the hospital and Mr. Rows represented the Attorney-General. No parties objected and Mr. Jama was excused from attending the hearing pursuant to s. 672.5(10) of the Criminal Code.
The parties were canvassed as to their initial positions. Ms. Zamprogna stated the hospital’s position, that Mr. Jama remains a significant threat to the safety of the public and should be continued on his current disposition with three changes: add ‘delegate’ to passes to permit Mr. Jama to be accompanied by a DSO worker; remove the abstain clause; and increase reporting to a minimum of four times per month. Mr. Rows joined the hospital position. Ms. Bhamra indicated that her client concedes the issue of significant threat but requests a conditional discharge disposition.
The evidence at the hearing was comprised of the Hospital Report dated April 22, 2025 (Exhibit 1) and an addendum to that Report dated June 10, 2025 (Exhibit 2). Dr. N. Mokhber, Mr. Jama’s attending psychiatrist, gave oral evidence.
In closing submissions, the parties maintained their initial positions.
Index Offences
- The details of the index offences are summarized as follows:
On Sunday, June 18, 2017, the accused was yelling at employees and residents of the Windsor Downtown Mission and refusing to leave the area. He was subsequently arrested for breach of the peace.
On Monday, June 19, 2017, a security officer for the Windsor Downtown Mission found the accused at the front door of the Mission, trying to get in. The security officer told the accused that he couldn't be there to which the accused replied, "no, no, this is where I want to live, this is where I'm going to stay”. The accused tried to push past the security officer as he entered the Mission, and kept trying to gain access after the security officer had entered and locked the door behind him. The accused left the Downtown Mission and immediately went to The Sanctuary.
A security officer at The Sanctuary saw the accused at the doors and told him that he wasn't allowed to be there and to leave immediately. The accused responded by asking if the female victim was working. The accused gave the security officer a hula girl dashboard ornament and asked that he give it to the female victim. The security officer told the accused to leave, and the accused told the security officer that he was going to marry the female victim, and that he loved her. The accused remained in the area, looking around the corner of the building and attempting to climb the property fence, leaving when he heard police sirens.
The female victim provided a statement to police advising that she was being constantly stalked by the accused and that he was totally obsessed with her. When the female victim found out that the accused had been to the Downtown Mission her "heart sank" and she "was in shock"…. The female victim is terrified of the accused and didn't want to go to work until she knew he was arrested.
Background and Treatment History
Mr. Jama’s background, criminal history and psychiatric history are set out in detail in the exhibits and need not be repeated in detail. What follows is a summary excerpted from last year’s Reasons for Disposition.
Mr. Jama was born in Somalia where he spent almost 10 years in a refugee camp and was reportedly exposed to war-related violence. He immigrated to Canada in 2007 with his mother and siblings although his father remained in Africa and passed away in 2011. Mr. Jama has reported that he was physically abused by his mother during childhood and sexually abused by a male when he was eight years of age. He went into the care of the Children's Aid Society and became a ward of the Crown at age 16.
It is reported that Mr. Jama displayed antisocial behaviours including aggression when he was in foster care at age 14. These included running away, breaking rules, truancy and destruction of property. He was suspended from school. He was drinking alcohol by age 13 and using cannabis daily in his teens. He has an extensive history of drug use which includes methamphetamine, cocaine, fentanyl and opiates. He was injecting crystal methamphetamine daily for a period of time, including on the day of the index offences.
Mr. Jama achieved a grade 9 education. He has no history of gainful employment. At the time of the index offences Mr. Jama was reported to be homeless and living in various shelters.
Mr. Jama has a criminal record that includes convictions for numerous breaches of court orders, possession of property obtained by crime and possession of substances for the purpose of trafficking. There is also reported to be a history of violence against family members, including his mother.
Mr. Jama had multiple hospital admissions during the period 2016 to 2017, before the commission of the index offences.
Following the NCR finding on April 3, 2018, Mr. Jama was an inpatient at the hospital for approximately four and a half years. During that time there was one incident of concern when he showed aggression to a nurse after a return from a community pass. The nurse was struck on the head several times and suffered a concussion. This occurred before clozapine was introduced in 2020 and resulted in Mr. Jama being charged and pleading guilty in 2021 to a lesser offence of assault and receiving a suspended sentence and 18 months’ probation with a no contact provision. In August 2022 he used methamphetamine when out in the community and did not disclose same until his toxicology screen returned positive. There were, however, no changes noted in his mental state.
Mr. Jama was discharged to community living on September 13, 2022, to Community Homes for Opportunity (CHO) located in St. Thomas, where his medication and meals are provided, and he receives a high level of support.
In the year following, in May 2023, his urine drug screens tested positive for cannabis and amphetamine use. There were subtle changes in his presentation, but he did not evidence overt decompensation. He was readmitted to hospital for several days to augment his education regarding the negative impact of substance use.
Mr. Jama’s urine tested positive for amphetamines on March 6, 2024. He was not readmitted to the hospital at that time.
Mr. Jama continued to live at the same CHO group home throughout the 2024-2025 reporting period.
Evidence at the Hearing
- Dr. Mokhber told the panel that this is the first year that Mr. Jama did not use substances.
She emphasized that this is a positive achievement for Mr. Jama. The doctor attributed this achievement to the treatment team’s frequent contact with Mr. Jama throughout the year.
Dr. Mokhber also believes that Mr. Jama did not use substances this year because he knew he would have to return to the hospital. Substances affect Mr. Jama’s memory, mental processing and analysis.
The hospital is recommending the removal of the abstain clause to assess whether Mr. Jama can remain free of substances in the absence of an abstain clause and in the context of extensive support by the treatment team and the group home staff. The reason for increasing the frequency of reporting is to enable the treatment team to observe Mr. Jama more closely for any signs of substance use or decompensation.
Dr. Mokhber testified that Mr. Jama’s diagnoses have been updated to include Avoidant Personality Disorder (APD) and Mild Cognitive Disability, in addition to the diagnoses of Schizophrenia and Substance Use Disorder (in early remission) listed in the Hospital Report.
Mr. Jama does not currently experience any positive symptoms of schizophrenia. His current symptoms are a combination of residual symptoms of schizophrenia, avoidant personality disorder, and mild cognitive disability.
Mr. Jama is impacted by severe memory issues. As an example, Dr. Mokhber described how Mr. Jama knows that clozapine helps to prevent hallucinations, but he forgets. On June 16 he asked Dr. Mokhber why he needed to take medication when he has no symptoms of schizophrenia. Mr. Jama is capable to make treatment decisions, but he requires frequent reminders that schizophrenia cannot be cured, and his symptoms will return if he stops the medication. Keeping him adherent to his medication schedule requires constant support from the treatment team and group home staff.
Memory and cognitive function also affect Mr. Jama’s ability to benefit from psychoeducational programming. The treatment team is tailoring a program for Mr. Jama which divides the normal program content into very small steps. The doctor told the panel that constant repetition is required, and Mr. Jama frequently forgets the content.
Dr. Mokhber told the panel that a new behavioural analyst and a new social worker recently joined the treatment team. The doctor is hopeful that Mr. Jama will be able to make progress with the assistance of these two new professionals. The treatment team is trying to bring together all the supports possible to help Mr. Jama to participate in society.
On a positive note, Mr. Jama has expressed some interest in volunteering, for example in an animal shelter. The treatment team will need to escort him to show him how to do the volunteer work, and to help him to structure his day.
Mr. Jama’s response to treatment is further complicated by personality disorder. The doctor testified that it is very difficult to treat a person with APD.
In the Addendum to the Hospital Report, Dr. Mokhber wrote:
… the diagnosis of avoidant personality trait is amended to Avoidant Personality Disorder (APD). The change from trait to disorder signifies that the avoidant tendencies are not only present but are pervasive and cause clinically significant distress and functional impairment.
At this time, the patient is not engaged in any formal treatment and has expressed limited motivation to participate in psychotherapy or other recommended interventions. This reluctance is consistent with the features of Avoidant Personality Disorder, particularly pervasive social withdrawal, fear of negative evaluation, and low self-esteem, which often interfere with help-seeking behavior. While evidence-based treatments such as Cognitive Behavioral Therapy (CBT) and pharmacological support with SSRIs remain clinically indicated, the current focus will be on maintaining engagement through low-pressure follow-up and psychoeducation. The treatment plan will remain flexible, with an emphasis on building therapeutic rapport and readiness for change over time. Alternative supports, such as self-guided resources or brief supportive check-ins, may be considered as interim steps should the patient become more open to intervention.
The treatment team must go to the group home to visit and provide checkups/programming for Mr. Jama. Dr. Mokhber told the panel that Mr. Jama avoids coming to the hospital, even for checkups. He cancels appointments for no given reason. In the past, the hospital made use of the Warrant of Committal to bring Mr. Jama back to the hospital because he has not returned to the hospital voluntarily.
The hospital is hoping to make use of a DSO worker in the upcoming year. This is the reason that the hospital is asking to amend the Disposition to provide that a ‘delegate’ can accompany Mr. Jama on passes.
Dr. Mokhber told the panel that a detention order is necessary to maintain Mr. Jama’s current level of well-being. Prior to treatment with the oral medication, clozapine, Mr. Jama was violent and aggressive. Without constant support and supervision by the treatment team, and the support and structure provided by the group home staff, Mr. Jama would not be able to remain compliant with his treatment regime.
Similarly, Mr. Jama has been substance-free for only one year. Without the support and supervision of the treatment team reminding him of the consequences of substance use, Mr. Jama would not likely remain abstinent.
In the event of mental decompensation due to medication non-compliance, or substance use, the hospital needs to be able to bring Mr. Jama to the hospital quickly. The hospital needs the Warrant of Committal because Mr. Jama will not come to the hospital voluntarily. He is capable of consenting to treatment, and it will therefore be difficult to bring Mr. Jama to the hospital for an assessment under the Mental Health Act.
Dr. Mokhber noted that Mr. Jama has not been violent over the past year, and with support has been cooperative with bloodwork and medications.
No additional evidence was provided by the parties.
Analysis and Conclusions
The Board finds that Mr. Jama continues to represent a significant threat to the safety of the public. We note that all parties concede this, but we make this finding independently on the evidence before us. We note that the Hospital Report sets out that Mr. Jama represents a low to moderate risk if maintained on a detention order, but the risk is elevated if he is on a lesser disposition. His risk factors include his significant history of violence. He has a history of violence in his teens with his family, and seriously assaulted a nurse when more unwell in hospital. Mr. Jama requires assistance in managing his medication. He would be unable to do so without close supervision. Although his schizophrenia symptoms have improved, he is still significantly impacted by his cognitive function and personality disorder.
As noted on pages 115 to 116 of the Hospital Report, Mr. Jama’s insight into the index offences is underdeveloped. He generally avoids discussing this topic. Mr. Jama’s insight into his mental illness has fluctuated over the course of the reporting period. He agrees with his diagnoses of substance use disorder and schizophrenia, although he has only a basic understanding of schizophrenia. He has been supported in the past through the hospital’s behaviour analyst with relapse prevention planning, but further work is needed to help him better understand the management and recovery aspects of his illness. Due to the absence of positive symptoms, he struggles to fully grasp the chronic and lifelong nature of his schizophrenia. While he is aware of his symptoms, he has difficulty identifying warning signs of decompensation. More psychoeducation needs to be provided in this regard. Mr. Jama requires ongoing health teaching to address his concerns about side effects and the role of his medications in managing his symptoms. Due to his cognitive challenges, traditional psychoeducation has proven difficult, and more tailored approaches are needed. He requires continued supervision and support in managing both pharmacological and non-pharmacological aspects of his treatment. His treatment is further complicated by APD, and his memory difficulties.
Mr. Jama’s insight into his violence risk is underdeveloped. Although he does not want to cause harm to anyone, he is unable to recognize the factors that increase his risk, such as substance use.
The panel carefully considered Ms. Bhamra’s submissions in support of a conditional discharge disposition. Ms. Bhamra suggested that the conditions include a consent-to- treatment clause, an abstain clause, a residential clause, a no contact clause, and a requirement to report a minimum of four times per month.
The panel finds that even with a consent-to-treatment clause, there is no guarantee that Mr. Jama will attend treatment given his cognitive and memory difficulties, and his avoidant personality disorder, which has prevented him from attending treatment in the past. Similarly, the abstain clause did not prevent Mr. Jama from using substances in the past. A Warrant of Committal was required to return him to the hospital.
The panel finds that a conditional discharge will not be sufficient to provide for Mr. Jama’s return to hospital. Mr. Jama is capable of consenting to treatment, and Box B criteria under the Mental Health Act will not apply to bring him back to the hospital in a timely manner before the risk to the public is too high. Even if Mr. Jama can be brought to the hospital for an assessment under the Mental Health Act, there is no guarantee that the hospital would be able to keep Mr. Jama in the hospital involuntarily for a sufficient amount of time to ensure that he is adequately stabilized. Only a detention disposition can ensure that occurs.
Mr. Jama has an avoidant personality disorder which makes it very difficult to connect with him. He has missed many outpatient appointments in the past year. Mr. Jama resides at a 24/7 supervised home and the team is able to get updates from the home as to his mental status. Mr. Jama requires supervision to maintain his medication compliance, which is provided at his home.
The panel finds that Mr. Jama’s disposition must be maintained as a detention order. At this time his risk cannot be managed under a lesser disposition. A detention order provides the assurance that Mr. Jama could be returned to and detained in hospital quickly if it is needed. Also, and of importance, he could be maintained in hospital for the appropriate period of time to address his needs and risk. On the evidence, the Mental Health Act would not suffice to provide for this. For these reasons a conditional discharge and the possible use of the Mental Health Act would not be sufficient to manage current risk.
The panel agrees with the changes to the Disposition recommended by the Hospital and the Attorney-General, for the reasons given by Dr. Mokhber, and noted earlier in these Reasons. The removal of the abstain clause is the next step in assessing Mr. Jama’s ability to live in the community with fewer restrictions while maintaining abstinence from substances. This is a positive step forward in Mr. Janma’s progress through the forensic system and represents the least onerous and least restrictive disposition.
For all these reasons, the Board finds that Mr. Jama’s disposition should be continued with the changes recommended by the hospital. We do so in recognition of the primary factor of protection of the public and in consideration of Mr. Jama’s mental health, his reintegration into the community and his other needs.
The Board congratulates Mr. Jama on a year of abstaining from substance use and encourages Mr. Jama to continue to develop a good relationship with the treatment team.
DATED this 22nd day of July 2025, at the City of Toronto, in the Region of Toronto.
Ms. K. Tomaszewski Legal Member
Office of the Registrar Ontario Review Board