Re: Masood Malikzai
ORB File No.: 8118
Hearing held on: Tuesday, August 19, 2025
Place of hearing: Waypoint Centre for Mental Health Care
Pursuant to: Sections 672.48(1) and 672.81(1) of the Criminal Code
Before:
Alternate Chairperson: Mr. J. Weinstein
Members: Dr. S. Simpson
Dr. J. Cheston
Ms. K. Tomaszewski
Ms. D. Smith
Parties Appearing:
Accused: Masood Malikzai
Counsel: Mr. D.N. Hotz (via Zoom)
The person in charge of hospital: Representative: Ms. T. Newman
Attorney General of Ontario: Counsel: Ms. S. Curry
REASONS FOR DISPOSITION
(Dated September 4, 2025)
Introduction:
On April 14, 2022, Mr. Masood Malikzai was found unfit to stand trial on account of mental disorder (“unfit to stand trial”), on charges of assault (x2), uttering threats to cause death, failure to comply undertaking (x2), fail to appear court and fail to appear prints, all contrary to the Criminal Code of Canada (“Criminal Code”).
Mr. Malikzai is currently subject to a Decision and Disposition of the Ontario Review Board (the “Board”), dated September 6, 2024, finding him unfit to stand trial and detaining him at the Waypoint Centre for Mental Health Care – High Secure Provincial Forensic Programs (“Waypoint”).
On August 19, 2025, the Board convened a hearing at Waypoint to conduct the annual review of the current Disposition.
Mr. Malikzai was represented by his counsel, Mr. N. Hotz, who appeared by Zoom, and who advised that his client did not wish to attend this hearing. An order was made, pursuant to s. 672.5(10)(a), allowing Mr. Malikzai to be absent from this hearing.
A Hospital Report, dated August 5, 2025 (the "Hospital Report"), was entered as Exhibit 1. A Fitness and Clinical Assessment of Risk (“Fitness Report”) was entered as Exhibit 2.
In accordance with s. 672.48(1) of the Criminal Code, the Board must decide whether Mr. Malikzai is unfit to stand trial on the day of the hearing, within the meaning of s. 2 of the Criminal Code. Specifically, is Mr. Malikzai unable, on account of mental disorder, to understand the nature of a trial and the possible consequences of the proceedings and to communicate with counsel? The other issues before the Board are whether Mr. Malikzai is permanently unfit, and if so, whether he remains a significant threat to the safety of the public.
If Mr. Malikzai is found fit, he must be sent back to court. If he is found unfit, but not permanently so, the Board must make a Disposition that is necessary and appropriate, considering the criteria set forth in s. 672.54 of the Criminal Code. Similarly, if he is found to be both permanently unfit and a significant threat, the Board must determine the appropriate Disposition. If he is not found to pose a significant threat to public safety, he must be returned to the court.
For the reasons set out below, and based on the evidence before us, this Board has concluded that Mr. Malikzai is unfit to stand trial. The Board further concluded that Mr. Malikzai is not permanently unfit. The Board also found that the necessary and appropriate Disposition required to manage Mr. Malikzai’s threat to public safety is a continuation of the existing Detention Order.
Outstanding Charges
- The circumstances of the allegations against Mr. Malikzai are excerpted from last year’s Board Reasons, as follows:
“Assault
... Tuesday, August 24, 2021, at 954 Audley Road North, in the Town of Ajax, Region of Durham, the accused, Masood MALIKZAI did commit an assault on Hela MALIKZAI, contrary to Section 266 of the Criminal Code of Canada. At approximately 0800 hrs, Masood placed Hela in a choke hold and strangled her. Masood also kicked and punched Hela in the neck and torso. Hela provided a witness statement advising he kicked her on her side and put "his arm around my neck pressing it and keep saying I will kill you now". Hela's mother and uncle attempted to help pull Masood away from her and they were unable to intervene. Instead, he dragged her on the floor from the kitchen to the living room. He proceeded to punch her in the chest and head...Hela sustained bruising to the neck...
Utter Threats
On ... Tuesday, August 24, 2021, at 954 Audley Road North, in the Town of Ajax, Region of Durham the accused, Masood MALIKZAI did, by word of mouth, knowingly uttered a threat to cause death to Hela MALIKZAI, contrary to Section 264.1, subsection (1), clause (a) of the Criminal Code of Canada...Hela provided a witness statement at Ajax Pickering Hospital where she was being assessed for physical injuries. In her witness statement, she advised that Masood stated, "leave me alone otherwise I will push you from the stairs I will kill you". The threats were followed by a physical assault. Masood uttered an additional threat during the assault, stating, "I will kill you now", while his arm was around Hela's neck...
Fail to Appear Court and Fail to Appear Prints
On September 22, 2021, at the City of Oshawa, the accused, being at large on an undertaking, was required to attend for fingerprints and photographs. On this date the accused did not attend and did not send a message to explain the absence.
On September 29, 2021, at the City of Oshawa, the accused, being at large on an undertaking, was required to attend court. On this date the accused did not attend and did not send a message to explain the absence.
Failure to Comply with Undertaking
On Friday, December 17, 2021, ... at approximately 1301 hrs [a police officer] was dispatched to attend a suspicious person call at 954 Audley Road North [Town of Ajax, Region of Durham]. The complainant Hela MALIKZAI had contacted police to advise that her brother had shown up at the family residence approximately 2 hours ago and that he had a warrant for his arrest. The complainant further advised of her brother’s mental state explaining that he had schizophrenia and was not currently medicated. [When police attended the residence, they] were given permission to enter...and... walked upstairs to find Masood sitting on the couch in the living room listening to music on the TV at a high volume. He refused to turn down the volume so [the officer] turned the TV off. Police explained to Masood that he was breaching his conditions by being here.
[One of the police officers attending the residence] had already reviewed Masood’s CPIC return and knew he was on conditions from an undertaking to remain away from this residence after assaulting his sister, the complainant, earlier this year.
Masood remained seated on the couch and was difficult to speak with as he continually spoke over top of officers. After realizing that we [the attending police officers] were not going to be able to successfully speak with Masood, he was advised he was under arrest ...for failing to comply with his Undertaking.
Assault
On December 13, 2021, at 580 Harwood Av S, Lakeridge Health Ajax Pickering Hospital, in the Town of Ajax, Region of Durham, on the third floor Mental Health Unit, the accused, Masood MALIKZAI did assault the victim [name] contrary to section 266 of the Criminal Code and the amendments thereto. On the above-mentioned date, the accused was a patient at Lakeridge Health Ajax Pickering Hospital, Town of Ajax and was being held in the Intensive Psychiatric Unit at the facility. The victim is a registered nurse and is currently employed by Lakeridge Health Ajax Pickering. On this date, the accused had got into a verbal altercation with another patient in the unit.
The victim intervened to try and resolve the issue as part of her duties of her employment. At this moment, the accused started to follow the victim in an aggressive manner in the unit hallway. The accused continued to get confrontational with the victim, stomping at her, striking her right foot. At this point, the victim attempted to retreat back into the nursing station fearing for her own safety. The accused followed, locking his right arm around the victims’ face and neck, placing her in a choke hold for approximately 4 seconds. The accused then pushed the victim to the ground, letting go of the choke hold as other hospital staff attempted into intervene.
The accused was subsequently charged with assault.”
- Mr. Malikzai’s history and background are outlined in the Hospital Report, and they are accurately summarized in last year’s Reasons:
“Although Mr. Malikzai was found fit to stand trial at his initial ORB hearing in August 2022, when he returned to court on December 23, 2022, he was found to be unfit and returned to Ontario Shores Centre for Mental Health Sciences (“Ontario Shores”) where he had been detained pending his return to court.
Thereafter, Ontario Shores requested an early hearing to review Mr. Malikzai’s fitness to stand trial and his suitability for continued detention at their medium-secure facility. On March 13, 2023, the Board was of the unanimous view that Mr. Malikzai was unfit to stand trial and that he should be transferred to Waypoint.
Mr. Malikzai was admitted to Waypoint’s Forensic Assessment Program (FAP) on April 5, 2023, and was transferred from the FAP to the Beckwith Program on January 18, 2024. Of note, the Beckwith Program is comprised of Waypoint’s most structured units.
The Hospital Report contains considerable detail with respect to Mr. Malikzai’s personal and mental health history and as such need not be repeated here. Briefly, his family left Afghanistan due to the war when he was a boy following which they lived in Pakistan until he was about 15 years old. In 1998, he immigrated to Canada with his family. His father has since passed away from colon cancer. Not much is known about Mr. Malikzai’s early developmental history except that he was reported to have never been suspended or expelled from school.
Mr. Malikzai graduated from high school and started studying business administration in college but did not complete the course, reportedly because he “wanted to travel and make big money.” He does not have a significant employment history. Mr. Malikzai is single and has no children. Prior to the alleged index offences, he lived with his mother, sister, and uncle in Ajax; they have continued to be supportive of him through his many difficulties. His sister, Hela, was and continues to be his primary support within the family. She is his substitute decision maker (“SDM”) for treatment with psychiatric medication.
As for his psychiatric history prior to the alleged Index Offences, a review of the Hospital Report reveals that commencing in 2014, Mr. Malikzai had many attendances and short- term admissions to Rouge Valley Centenary Hospital and Lakeridge Health for assessment and stabilization, secondary to medication non-adherence and aggressive behaviour towards family members, including his sister, sister-in-law and his uncle. He often presented as disorganized, with prominent paranoid, somatic, grandiose, and religious delusions. He was paranoid about medication and accused staff of touching him sexually and physically harming him. He had no insight into his illness or need for treatment, frequently demanded to leave hospital or was actively exit-seeking, and often agitated and aggressive towards staff.
In 2016, he reportedly stole a metal scraper from housekeeping staff at Rouge Valley and hid it in his bedding, later acknowledging he took it for “self-defense”, believing that hospital staff were going to kill him. In September 2020, he was admitted to Lakeridge after telling his family he was going to get a gun and kill himself and his mother. At times he required locked seclusion and chemical restraint to control his aggressive behaviour. He was trialed on a number of anti-psychotic medications, with variable effect. Mr. Malikzai was subject to a series of Community Treatment Orders (CTOs) from at least 2016 and was often discharged from hospital prior to resolution of his symptoms. He was on a CTO at the time of the alleged Index Offences in August 2021. Overall, it appears clear from the narrative set out in the Hospital Report that community- based treatment initiatives were ineffective at managing his illness and his aggressive behaviour towards others.
Mr. Malikzai does not have a criminal record but the Hospital Report makes reference to a number of instances where he has had contact with the police quite apart from the alleged index offences (e.g. he was involved in a physical altercation with police on August 8, 2020 following an attempted abscondment from Lakeridge Hospital, and on January 26, 2021 he was brought to Lakeridge Hospital by police after [reportedly] having hit his older brother, slapped his uncle and threatened both of them with a knife. In November 2021, after [reportedly] assaulting his uncle, he was described as being “aggressive” with police, and “violently responding to unseen stimuli”.
There are notable contradictions in the Hospital Report regarding Mr. Malikzai’s historical use of substances (cannabis, alcohol), but there is no suggestion that his substance use caused his psychosis as these symptoms seemingly pre-dated his substance use and persisted during periods of presumed abstinence. However, his use of substances is thought to have exacerbated his psychiatric symptoms.”
Course Since Last Disposition
- Mr. Malikzai’s course since his last Disposition is set out in detail in the Hospital Report and in the Fitness Report. The following extracted paragraphs are relevant to this hearing:
“Mr. Malikzai remains on unit B of the Beckwith program. Notably, the Beckwith program is one of the most structured programs within the high secure provincial forensic programs at the Waypoint Centre for Mental Health Care (Waypoint). Dr. P. Ismail is his attending psychiatrist.
Mr. Malikzai continues to experience paranoia and grandiose delusions.
Mr. Malikzai believes his auditory hallucinations are real and is not receptive to redirection during periods of responding. He is also observed shadow boxing, and it is believed this is in response to internal stimuli. He also appears preoccupied, and experiences thought broadcasting.
Mr. Malikzai has not required seclusion during this review; however, a unit lock- up has been necessary three times for him to return to his room when he has been agitated. The most recent was April 19, 2025, when Mr. Malikzai clenched his fists during a discussion about taking medications.
Mr. Malikzai continues to deny his charges and any wrongful acts. He believes he has been pardoned and becomes angry when anything to the contrary is presented. Mr. Malikzai would not accept documents from the Ontario Review Board (ORB), and when given his Disposition, he told the social worker that he was being released and just waiting for his ride to pick him up. He requested that his Notice of Hearing be shredded.
In December 2024, Mr. Malikzai participated in his Prima Facia hearing, virtually. His speech was pressured as he said that he was held against his will and was to be released. Due to his inability to refrain from interrupting and listen quietly to the proceedings, his microphone was muted. At the Pre-Board Conference, the psychometrist noted a recent very slight improvement with respect to fitness, but that Mr. Malikzai is unable to tolerate more than a few minutes of discussion.
Mr. Malikzai does not appreciate his legal circumstance, and his request to leave the hospital is unwavering. He does not believe he has done anything to warrant being detained.
During an episode in April 2025, he threatened to shoot a staff member in the face. He has also demonstrated behavioral instability, including spitting on the floor, shouting in response to hallucinations, and shadowboxing. Unit lockups have been required to manage agitation, most recently when he became physically threatening during a discussion about medication. He has required revocation of independent access privileges due to exit-seeking behavior, and he remains at moderate risk of elopement. His Crisis Prevention Plan highlights delusional beliefs and protective ideation toward family members as high-risk triggers.”
Position of the Parties
The representative for the hospital asserted that Mr. Malikzai was unfit to stand trial, but not permanently so. The appropriate Disposition would be a continuation of the existing Detention Order.
Counsel for the Attorney General joined the hospital in their recommendation. Counsel also advised that, the charge of fail to comply, from November 17, 2021, was withdrawn; it was not in the public interest to continue with this charge, given that Mr. Malikzai was under the jurisdiction of the Board for two more serious charges.
Counsel for Mr. Malikzai was unable to take a position in this matter, as his client cannot meaningfully communicate instructions to him.
Evidence at the Hearing
The Board had available to it the evidence and documents forming the Record, the Exhibits, and oral evidence from Dr. Ismail.
Dr. Ismail co-authored the Hospital Report, and he testified as follows:
a) He read, and adopted, the contents of the Hospital Report and the Fitness Report.
b) He most recently assessed Mr. Malikzai’s ability to be fit for trial yesterday.
c) Mr. Malikzai continues to be unfit for trial. He cannot engage in conversation about his Outstanding Charges or his diagnoses, becoming very angry and belligerent when an attempt is made to discuss these issues with him. Mr. Malikzai continues to maintain that he has been pardoned for all charges. He relies on his delusional beliefs, which interfere with his ability to engage meaningfully with the doctor.
d) He is not prepared to find Mr. Malikzai as being permanently unfit because they have seen some positive response to his medication regimen. Furthermore, should Mr. Malikzai be willing to engage in electro convulsive therapy (ECT), in the future, there is a possibility that he would become fit.
e) Mr. Malikzai is currently on three antipsychotic medications. Historically, Mr. Malikzai has had to be placed into seclusion numerous times, both at Ontario Shores and at Waypoint. However, he has not required seclusion this past reporting year.
f) Previously, Mr. Malikzai did not have any engagement with his family. However, he does now engage with his family, as well as with staff and co-patients.
g) The treatment team has seen a decrease in the intensity, and frequency, of Mr. Malikzai’s psychotic symptoms.
h) According to Mr. Malikzai, he does not have a mental illness, all his charges have been pardoned, and he should be allowed to leave the hospital.
i) Mr. Malikzai continues to engage in exit-seeking behaviour.
j) As set out in the Hospital Report, Mr. Malikzai is only comfortable accepting his medications from certain staff members. When those staff members are not available, it takes many hours to convince him to follow his medication regimen.
k) If Mr. Malikzai were in a less secure facility, he would elope from it.
- In response to questions from counsel for the Attorney General, Dr. Ismail testified:
a) Mr. Malikzai’s ongoing delusions that he has been pardoned would interfere with his ability to properly instruct counsel about his case, as well as his ability to participate in a trial.
- In response to questions from counsel for Mr. Malikzai, Dr. Ismail testified:
a) Mr. Malikzai’s recurring delusions are that he is being held at Waypoint as a prisoner of war for millions of years and he has worked for various clandestine intelligence agencies, such as CIA and Mossad. He also has ongoing, grandiose delusions that he is the Prince of Iran and needs to be discharged immediately from the hospital, as well as that he owns the hospital, all staff work for him, and he can fire them at will.
b) He has seen some improvement in Mr. Malikzai’s delusions; he now tends to keep these delusions to himself, and they only surface when he is engaged in a conversation about a potential trial.
c) If Mr. Malikzai were able to manage his behaviour and not engage in exit-seeking behaviour, he would be able to enjoy more privileges at the hospital. At one point, Mr. Malikzai did have C5 privileges, which are independent privileges off the unit, and he was able to manage them for roughly six days.
- In response to questions from the panel, Dr. Ismail testified:
a) Mr. Malikzai is not able to understand the nature, or object, of proceedings. He does not understand the possible consequences of any proceedings, nor is he able to meaningfully communicate with counsel.
b) Mr. Malikzai does not have a reality-based understanding of the decisions that are available to him, including what to plead, whether to testify or what witnesses to call.
c) Mr. Malikzai’s mental disorder cannot be described as transient or fluctuating, and no reasonable accommodations could be made to allow him to appear in court. Mr. Malikzai’s mental disorder impairs his understanding of reality and his ability to communicate with counsel.
d) The following paragraph from last year’s Reasons for Disposition is still true today:
“In his oral evidence, Dr. Ismail advised the Board that notwithstanding treatment with three types of antipsychotic medication, Mr. Malikzai remains very symptomatic, regularly expressing paranoid, persecutory ideation and delusions of grandeur, religiosity, and delusions of conspiracy. He is not oriented as to time or place; he believes he is an international business student who is being held in hospital against his will. His delusions are such that they pose barriers to treatment in that they cause him to be hostile to staff and opposed to alternate forms of therapy that might be more effective than the medication he is currently prescribed. For example, he believes staff are stealing his bodily fluids for the purpose of experimentation and thus will not participate in the regular blood testing that is a requirement for clozapine administration. Similarly, he refuses to participate in electroconvulsive treatment (ECT) because he views it through the lens of his delusions as a form of torture at the hands of staff.
e) Paragraph 38 from last year’s Reasons still applies today, although the frequency, and intensity, of Mr. Malikzai’s threats have diminished since last year:
“As to the necessary and appropriate Disposition, Dr. Ismail opined that Mr. Malikzai’s current presentation warranted continued detention at Waypoint. Were Mr. Malikzai detained in a medium-secure setting, Dr. Ismail felt he would likely spend the majority of his time in seclusion. At Waypoint, staff are extremely familiar with his triggers and behaviours and are able to manage him without having to resort to seclusion for the most part. In addition, Mr. Malikzai has the benefit of skilled seclusion-relief for those periods of time when he has to be secluded for the safety of himself or others. He continues to regularly direct threats of violence to staff and believes that he is being subjected to various forms of torture by them. He has nevertheless been able to make some modest gains towards increased privileges within the confines of the highly structured Beckwith program where he resides.”
- No other evidence was called.
Analysis and Conclusions
Fitness to Stand Trial
- The first issue for the Board to decide is whether Mr. Malikzai remains unfit to stand trial.
Applicable Law
- The Supreme Court of Canada addressed the fitness test, most recently in R v Bharwani, 2025 SCC 26 (“Bharwani”). In this decision the Supreme Court emphasized the following with respect to the fitness test:
a) Fitness to stand trial does not require an accused to make decisions in their best interests. Instead, “it requires making decisions based on an understanding of reality that is not overwhelmed by delusions, hallucinations, or other symptoms of their mental disorder.”1
b) The accused is fit to stand trial if they can “make and communicate reality-based decisions in the conduct of their defence or instruct counsel to do so”2 and “intelligibly communicate these decisions to counsel or the court.”3
c) Conducting a defence involves “making decisions that an accused must always make personally and those which relate to the exercise of their right to full answer and defence, such as decisions about pleas, the mode of trial, selection of counsel, whether to testify, whether to call or cross-examine witnesses, and closing submissions, among others.”4
d) The “capacity” required to make these decisions includes “a reality-based understanding of the nature or object of the proceedings and their possible consequences, an ability to understand the available options and their consequences, and an ability to select between those options when making decisions.”5
e) “Transient” mental health symptoms do not necessarily compromise an accused’s ability to conduct a defence. The focus is “always on assessing the extent to which an accused’s mental disorder impairs their understanding of reality when making and communicating decisions in their defence.”6
f) The fitness to stand trial test is “contextual,” and the inquiry “focuses on the decisions that form part of an accused’s defence in a specific case, and not in the abstract.”7
g) The same test for fitness to stand trial applies to all accused whether they are represented by counsel or not.8
Determination on Fitness
Having heard and considered all of the evidence and submissions from the parties, the Board agrees with the joint submission of the parties, that Mr. Malikzai is unfit to stand trial. Mr. Malikzai is unable to: understand the nature, object, and possible consequences of the proceedings; communicate meaningfully with counsel; meaningfully participate in a trial; or instruct counsel in a criminal proceeding.
Mr. Malikzai’s mental health symptoms cannot be described as transient. Mr. Malikzai’s mental health disorder does compromise his ability to conduct a defence, and it would impair his understanding of reality when making, or communicating, decisions in his defence.
In Clayton (Re), 2025 ONCA 308, the Court of Appeal for Ontario held that “the nature of the charges and allegations” facing an accused is important context when applying the fitness test. In particular, at paragraph 11, “the simpler the case is, the easier it is to understand, appreciate and talk about.”9
The Board finds that Mr. Malikzai’s criminal charges are reasonably complex and serious. This is not a straightforward, simple case; there are two charges of assault as well as a charge of uttering threats to cause death.
In particular, the Board relies on the following extracts from the Hospital Report and the Fitness Report:
“Mr. Malikzai continues to deny his charges and any wrongful acts. He believes he has been pardoned and becomes angry when anything to the contrary is presented. Mr. Malikzai would not accept documents from the Ontario Review Board (ORB), and when given his Disposition, he told the social worker that he was being released and just waiting for his ride to pick him up. He requested that his Notice of Hearing be shredded.
In December 2024, Mr. Malikzai participated in his Prima Facia hearing, virtually. His speech was pressured as he said that he was held against his will and was to be released. Due to his inability to refrain from interrupting and listen quietly to the proceedings, his microphone was muted. At the Pre-Board Conference, the psychometrist noted a recent
very slight improvement with respect to fitness, but that Mr. Malikzai is unable to tolerate more than a few minutes of discussion.
Mr. Malikzai does not appreciate his legal circumstance, and his request to leave the hospital is unwavering. He does not believe he has done anything to warrant being detained.”
Necessary and Appropriate Disposition
- The Board finds the Disposition that is necessary and appropriate in the circumstances is the continuation of the existing Detention Order. In particular, the Board relies on the following extracts from the Hospital Report and the Fitness Report:
“Mr. Malikzai continues to present with active symptoms of a major mental disorder, namely schizophrenia, including persistent grandiose and paranoid delusions, auditory and visual hallucinations, thought broadcasting, and disorganized behavior.
Insight remains significantly impaired across all domains. Mr. Malikzai denies having a mental disorder, refuses to acknowledge any violent behavior or legal wrongdoing, and believes he has been pardoned. He continues to state that he is being released and dismisses legal documents, even requesting that his Notice of Hearing be shredded. His understanding of his risk for violence is limited; he is unable to identify personal, interpersonal, or contextual factors that contribute to his behavior. This lack of insight is entrenched, has shown no meaningful improvement, and is resistant to treatment efforts.
The team is concerned that in a less structured setting, non-compliance would likely escalate, resulting in symptom exacerbation and increased risk. Mr. Malikzai has displayed recent violent ideation and behavior.
The five Clinical items on the HCR-20 examine certain features regarding recent psychosocial adjustment that, if present in the past several months, are important to consider in terms of violence risk prediction and management. There is evidence to suggest that Mr. Malikzai has several Clinical risk factors of concern that have been exhibited during the rating period of approximately one year and are reviewed below.
Insight: Over the course of this review period, of approximately one year, Mr. Malikzai has denied that he is ill, denied that he needed medications and has indicated that he does not feel he needs the treatment offered here at Waypoint. On multiple occasions he has indicated that he has been inappropriately detained, and that staff should allow him to leave, often so he can smoke marijuana. As such, Mr. Malikzai has little insight into his mental illness, his need for treatment, his need to adhere to medication and his need to refrain from using drugs or alcohol.
Violent Ideation: Mr. Malikzai has a significant history of exhibiting physical violence towards others, however as his violence appears to be largely driven by his major
mental disorder. As such, his violence appears best described under Symptoms of Major Mental Disorder, outlined below.
Symptoms of Major Mental Disorder: Mr. Malikzai has been noted to respond to unseen stimuli, has voiced unusual thoughts such as his medications and food being poisoned, voiced persecutory beliefs, voiced paranoid thoughts, and at the start of the review period, he was more sensitive to provocation. In the past, Mr. Malikzai has been quite labile and exhibited physical violence, however over this review period, his violence has been limited to verbally threatening others, which occurred on several occasions. At present, Mr. Malikzai is more stable, less labile, and able and willing to engage with staff however the content of his verbiage continues to be unusual, somewhat scattered and confusing at times.
Instability: Mr. Malikzai had several instances of threatening others over the course of this review period, however these were short lived, and he quickly returned to his base line behaviour, as such, this risk factor is only partially present and appears to be improving with the treatment he has received while at Waypoint.
Treatment and Supervision Response: During this review period, Mr. Malikzai has been more accepting of engagement in therapeutic programming which includes more participation in Healthy Habits, Life Skills Programming, and engagement with the Recreation Therapist. His participation is somewhat inconsistent in that he will occasionally decline to participate without reason. As well, his medication adherence, while much improved from the last review period, has room for improvement as he is not always adherent. For instance, on one occasion, cleaning staff found a pill in his room and on other occasions, Mr. Malikzai has simply dumped the coffee containing his medications down the sink, left his partially consumed coffee behind or thrown his coffee onto the snow or lawn.
Mr. Malikzai currently resides in a secure, forensic setting, and as such, this residence has an element of uncertainty as individual rooms, co-patients, and staff, do change frequently. There is conflict among patients and staff respond to violent codes regularly. There are limited positive supports, and a high proportion of the patients have limited access to funds, indicating a high level of poverty. Should Mr. Malikzai be transferred to a less secure setting, this author would note that any increased access to drugs, alcohol, weapons, or vulnerable co-residents would all be considered to increase the risk Mr. Malikzai presents towards others. A likely re-offense scenario would involve Mr. Malikzai becoming non-compliant with medications leading to a decline in his mental status, an increase in his symptomology and an increase in his reactive behaviour. As well, any access to illicit substances, would also likely lead to a decline in his mental status, an increase in psychotic symptomology and an increase in his propensity to resort to violence.”
Permanent Unfitness
The Board is not prepared to find Mr. Malikzai is permanently unfit, for the reasons testified to by Dr. Ismail. Mr. Malikzai has shown some improvement in his symptoms and was not as aggressive this year as he was last year. He has been previously found to be unfit by the Board. Should he be willing to engage in ECT treatment, he may become fit to stand trial. The finding of permanent unfitness is quite a serious finding and should not be taken lightly.
In consideration of all the evidence, submissions of the parties and taking into consideration the criteria set forth in s. 672.54, namely the paramount consideration being the safety of the public, in addition to the mental condition of Mr. Malikzai, his reintegration into society and his other needs, the necessary and appropriate Disposition is continuation of the existing Detention Order.
DATED this 4th day of September 2025, at the City of Toronto, in the Region of Toronto.
Mr. J. Weinstein
Alternate Chairperson
__________________
Office of the Registrar
Ontario Review Board