Re: Rafina Hosein
ORB File No: 7877
Hearing held on: January 12, 2026
Place of hearing: Ontario Shores Centre for Mental Health Sciences 700 Gordon Street, Whitby
Pursuant to: Section 672.81(1) of the Criminal Code
Before:
Alternate Chairperson: Mr. L. Banks
Members: Dr. R. Sheppard Dr. L. Lightfoot Ms. C. Murray Ms. R. Chopra
Parties Appearing:
Accused: Rafina Hosein Counsel: Mr. T.R. McIver
The person in charge of hospital: Representative: Mr. Kyle Dow
Attorney General of Ontario: Counsel: Ms. N. MacDonald
REASONS FOR DISPOSITION
(Dated February 20, 2026)
Introduction
On April 15, 2021, Rafina Hosein was found not criminally responsible on account of mental disorder on charges of criminal harassment (x2), fail to comply release order (x2) and fail to comply recognizance, all contrary to the Criminal Code.
Ms. Hosein is currently subject to an Ontario Review Board Disposition of January 22, 2025, which ordered her detained within the Forensic Program at Ontario Shores Centre for Mental Health Sciences with privileges up to and including to live in the community in accommodation approved by the person in charge.
On January 12, 2026, the Ontario Review Board convened at Ontario Shores Centre for Mental Health Sciences (“Ontario Shores”) to conduct Ms. Hosein’s annual review and to make a disposition further to s. 672.81(1) of the Criminal Code.
A Hospital Report dated December 17, 2025, was entered as Exhibit 1.
At the commencement of the hearing, the parties were canvassed as to their positions. Mr. Dow, on behalf of the hospital, recommended no change to the terms of the current Disposition, with the addition of “refrain from contacting or communication, direct or indirect (via phone, email, and in person), Dr. Mark Pearce”.
Ms. MacDonald, for the Attorney General, supported the hospital’s position.
Mr. McIver stated that Ms. Hosein would like a Conditional Discharge. She would agree to live in the community at her current address, agree to a Young clause requiring that she attend at the hospital for psychiatric assessment and readmission upon request of the person in charge, and report to the hospital twice weekly.
Index Offences
- The index offences are outlined in last year’s Reasons for Disposition as follows:
"Criminal Harassment x2
On November 9, 2018, the victim, the accused’s daughter Shivone, threw a birthday and did not invite the accused. This was in part due to her mother’s mental health problems and the difficulties she would create at the party. Ms. Hosein felt slighted and began a pattern of stalking and harassing the victim. Each day from November 9, 2018 to December 11, 2018 Ms. Hosein called the victim dozens of times leaving angry, rambling voicemails. On occasion, the victim would answer the call to tell the accused to stop calling. This had no effect.
Ms. Hosein would frequently attend the victim’s apartment and bang on the door. On December 5th, 7th and 10th, 2018, the accused pulled the fire alarm.
Fail to Comply x3
On January 20, 2020, Ms. Hosein attended the victim’s residence at approximately 5:00 a.m. and proceeded to bang on the door. The police were called and she was arrested for fail to comply with a court order to stay away from the victim’s residence.
On May 9, 2020, Ms. Hosein again attended this building, banging on the victim’s door. She was arrested for this breach of a court order.
On May 12, 2020, Ms. Hosein was in the lobby of the victim’s apartment building breaching a term to not attend at this building.”
Current Diagnoses
- Schizoaffective disorder, bipolar type
Alcohol use disorder, in remission
Cluster B personality traits
Background
The Hospital Report contains an extensive outline of Ms. Hosein’s personal, criminal and psychiatric background and should be referred to for detail.
Ms. Hosein is 61 years old. She was born in Trinidad. She was 22 years old when her father arranged her marriage. In 1988 she travelled to Toronto while pregnant with her second child, Shivone. She did not return to Trinidad and she and her husband eventually separated.
Eventually, Ms. Hosein entered a relationship with another man lasting for 18 years. She had another daughter. At this time, she began gambling and drinking excessively and would become verbally abusive. Her daughters were left alone, which led to Children's Aid removing the children from Ms. Hosein’s care.
Much of Ms. Hosein’s background information while in Canada comes from her older daughter, Shivone. For approximately four years, Ms. Hosein received treatment and medication through CAMH but after a year of progress the accused stopped taking her medication and began drinking and gambling again.
Historically, Ms. Hosein has been non-compliant with antipsychotic medications, as well as mood stabilizing medications. She typically deteriorated rapidly in the context of medication noncompliance, and it would take a relatively long period of time to re-stabilize her. When unwell, she exhibited paranoid and grandiose delusions. Her thinking would become disorganized, and she would become verbally aggressive and difficult to engage. Her verbal aggression, and threats of serious physical aggression, resulted in her needing to be placed into seclusion for varying amounts of time during inpatient psychiatric admissions. She has a history of lengthy admissions to various psychiatric hospitals, such as CAMH, Ontario Shores, Michael Garron Hospital, and St. Joseph’s Hospital. Many of these admissions were on an involuntary basis.
Although Ms. Hosein has no prior criminal convictions registered against her, she had been charged numerous times with harassment and uttering threats and failure to comply, all of which were either withdrawn or stayed. Most of these charges related to harassment against her daughter Shivone and involved Shivone’s two daughters.
On September 25, 2023, Ms. Hosein was discharged to an independent living apartment in Toronto. She continues to reside at this residence. She is currently seen by Forensic Outpatient Services (“FOS”) regularly, twice per week by a primary clinician, and approximately every six weeks by her psychiatrist. Ms. Hosein’s psychiatrist switched from Dr. Pearce to Dr. Bhullar in the summer of 2025 for administrative reasons.
During the reporting period, Ms. Hosein has asked to reduce the frequency of FOS visits several times. Ms. Hosein has been unable to meet the requirements for a reduction of frequency of visits.
In the past reporting year, Ms. Hosein has adhered to her medication regimen. Her insight into her mental illness and the need for medication is poor. She repeatedly asks to discontinue her long-acting antipsychotic injection and denies having a mental illness.
Insight regarding the index offences remains poor. When asked about the index offences, Ms. Hosein states, “This was just a misunderstanding.”
Ms. Hosein continues to be supported by the Ontario Disability Support Program.
Ms. Hosein did not exercise any leaves of absence this reporting period.
During this reporting period, Ms. Hosein left multiple voicemails and sent emails to her former psychiatrist, Dr. Pearce. In November 2025 she said, “I like him, like like him, now that he is not my doctor this shouldn’t be a problem.” Ms. Hosein was asked to stop the messages and emails. She then sent a picture of herself to Dr. Pearce. Despite repeated requests, Ms. Hosein continued to contact Dr. Pearce.
Over the past year, Ms. Hosein has declined to participate in individual therapy aimed at improving her insight into her psychotic illness, as well as recommended structured community programming.
Ms. Hosein remains incapable of consenting to psychiatric treatment. The Public Guardian and Trustee acts as the substitute decision maker.
Oral Evidence at the Hearing
Dr. Bhullar has been Ms. Hosein’s outpatient psychiatrist since the summer of 2025. She authored the hospital report and she endorsed its contents in her evidence today.
Ms. Hosein has been compliant with her long-acting injectable antipsychotic medication this year. She has requested that the nurse not give it to her but has been redirectable with the support of the nurse.
Dr. Bhullar stated that Ms. Hosein has not engaged in recommended programming this year. The programming was recommended with an intention of improving her insight. She also has not participated in recommended recreational programming. This is the reason that Forensic Outpatient Services (FOS) visits continue twice per week.
Ms. Hosein has limited insight into her inappropriate behaviours. Up to November 2025, Ms. Hosein called Dr. Pearce incessantly, left voice mails, emails, and provided a picture of herself asking Dr. Pearce how he liked her top. This incessant contact has been quite distressing for Dr. Pearce, which is why the hospital is requesting the no-contact order. There are parallels between her behaviours at the time of the index offence and her behaviours directed at Dr. Pearce. The no-contact clause is necessary to manage her risk to the safety of the public, specifically Dr. Pearce.
Ms. Hosein is superficial and guarded in her conversations with FOS. She does not understand how her behaviours, past and present, affect others psychologically. She has no insight into her mental illness and does not believe that she is ill.
Dr. Bhullar stated that the team unanimously agrees that there should be no changes to her Disposition, except for the addition of the no-contact clause related to Dr. Pearce.
A Conditional Discharge would be premature for Ms. Hosein at this time. Ms. Hosein has independent housing. Outside of the two FOS contacts weekly, Ms. Hosein has no other professional supports in the community. These two FOS contacts are the bare minimum needed for her to remain in the community.
Dr. Bhullar does not believe that the Mental Health Act (MHA) would be sufficient to keep Ms. Hosein in hospital were she to experience a decompensation in her mental status. Ms. Hosein’s symptoms rapidly deteriorate, historically, but are initially quite subtle. It is difficult to notice deterioration of her mental status because of her high level of guardedness and evasiveness. The team does not believe that Ms. Hosein would contact them if she were to experience decompensation. Ms. Hosein would not voluntarily re-attend at the hospital if requested. Even with subtle deterioration, there is an increased risk to the public because her behaviour would escalate. Dr. Bhullar believes that the MHA would not be sufficient to keep Ms. Hosein in hospital once she achieved a minimal level of improvement.
In response to questions of Mr. McIver, Dr. Bhullar testified that Ms. Hosein says she did some work in the Library Program, an Excel training program, but this has not been confirmed. She has failed to provide a letter from her teacher confirming completion of the program. For the programs the hospital has recommended, Ms. Hosein would need to provide her consent for the referral. She has not consented.
To receive a recommendation for a Conditional Discharge, Ms. Hosein would need to show that she is capable of abiding by the terms of her existing Detention Order Disposition, including compliance with the no-contact provisions. The team would also expect that she attempt to enhance her social network and attend programming. She is encouraged to take part in Cognitive Behavioral Therapy for psychosis, which will help to improve her insight into her illness and need for treatment. The team would also like to see her participate in concurrent disorders programming given her history of alcohol use, which has historically aggravated her mental illness.
Ms. Hosein’s behaviour regarding Dr. Pearce is driven by delusional thinking. In 2024, she developed erotomanic delusions. Today, her behaviour is partly driven by the delusional thinking and partly by her lack of social skills. Dr. Bhullar thinks individual therapy would help in this regard.
Mr. McIver submitted that Ms. Hosein would consent to a s.672.55 treatment condition. He said she would be prepared to meet with staff twice per week. He submitted that Ms. Hosein would agree to a term that she return to hospital for assessment and admission, if requested.
Dr. Bhullar stated that, regardless of any consent by Ms. Hosein to terms of a Young condition or treatment condition in a Conditional Discharge, the MHA would possibly not be sufficient as she might not meet criteria for readmission. Based on her recent history, police support would likely be necessary to return Ms. Hosein to hospital. Police support is not always readily available and, in the interim, Ms. Hosein’s behaviours would increase the risk of harm to the public.
Analysis and Conclusion
- In considering the issues of significant threat and the necessary and appropriate Disposition, the Board agrees with and relies upon the Clinical Assessment of Risk at page 35 of the Hospital Report.
Significant Threat
Having heard and considered the entirety of the evidence as well as the submissions from the parties regarding significant threat, the Board finds that Ms. Hosein remains a significant threat to the safety of the public.
As per the Clinical Assessment of Risk, Ms. Hosein’s violence risk factors include her major mental illness with breakthrough symptoms, a historical substance use disorder, maladaptive personality attributes, as well as poor insight into her mental illness, the need for treatment, and the index offences.
During this reporting period, Ms. Hosein has continued to engage in harassing behaviours by repeatedly contacting her former psychiatrist by voicemail and email, including sending him a photograph of herself. These behaviours continued to November 2025 despite repeated requests for her to stop. This behaviour mirrors her behaviour and presentation around the time of the index offences and demonstrates Ms. Hosein’s lack of insight into the impact of her prior harassing behaviour on her family. Dr. Pearce has expressed concerns that Ms. Hosein’s behaviour constitutes harassment, necessitating the hospital’s recommendation for a no-contact clause.
Ms. Hosein has requested medication changes and has repeatedly asked to discontinue her long-acting antipsychotic this reporting period. She has limited insight into her need for treatment and, based on her history and lack of insight, would likely discontinue her medication. This would likely result in rapid psychiatric destabilization. This would place her at high risk of causing serious psychological harm, and potentially physical harm, to members of the public.
Necessary and Appropriate Disposition
In light of the Board’s finding of significant threat, it is charged with shaping a Disposition for the coming year.
When unwell, Ms. Hosein has historically become irritable and difficult to engage with treatment providers. This reporting year Ms. Hosein has refused to participate in recommended programming and individual therapy, which are directed at improving her insight. She does not have insight into her need for treatment and has repeatedly requested a reduction in the number of FOS visits. She has asked to stop her antipsychotic medication. In mid-2024, when readmission was considered, she was adamant that she did not wish to return to hospital. This year her attempts to pull back from treatment and FOS visits makes it clear that she would not likely consent to voluntary readmission to hospital or remain in hospital for stabilization should the need arise, regardless of terms of a Disposition.
Ms. Hosein lives independently. With her guarded presentation and lack of insight, it is unlikely that she would recognize or report any deterioration in her mental status. She has few community supports and does not have employment. As such, changes in her mental status may go undetected until significant decompensation occurs. It is concerning that Ms. Hosein’s mental status deteriorated this year to the point that she engaged in harassing behaviors similar to those at the time of the index offences.
The Board considered a Conditional Discharge. However, it is clear that a Conditional Discharge would be premature at this time. The Board accepts Dr. Bhullar’s evidence that the signs of decompensation are subtle and the MHA might not be sufficient to readmit her to hospital, if necessary. The hospital needs the ability to readmit her expeditiously potentially before she would meet criteria for certification under the MHA. Further, the hospital needs the ability to maintain her in hospital until stabilized. It is uncertain these risk management goals could be reliably accomplished und the MHA with or without reliance on a Young clause.
The pattern of harassing behaviour has historical roots beyond those experienced by her family and Dr. Pearce. In 2012, Ms. Hosein had a brief relationship with a victim, Mr. L [name redacted for privacy]. Ms. Hosein had charges against her of Uttering Threats and Failing to Comply with a Recognizance in 2013 for repeatedly communicating with the victim. A Peace Bond was instituted in 2014 for Ms. Hosein not to communicate with the victim directly or indirectly. On November 17, 2014, Ms. Hosein entered into a Peace Bond with several conditions including that she not be within 50 metres of the victim or any place he lives or works. On October 6, 2015, the victim reported having received phone calls and several voice messages from Ms. Hosein the prior week. On October 6, 2015, Ms. Hosein was observed in the lobby of the victim’s building. Ms. Hosein was arrested.
The Board finds that there is clear evidence that Ms. Hosein’s harassing behaviours cause significant psychological harm to the victims. Ms. Hosein’s pattern of harassing behaviours extended this year to Dr. Pearce. A non-contact order with respect to Dr. Pearce is necessary to manage Ms. Hosein’s risk to the public.
The Board finds that the necessary and appropriate Disposition is a Detention Order on the same terms as last year with the addition of the non-contact term requested by the hospital, as set out in our formal Disposition.
In making the Disposition, the Board took into consideration all the evidence and submissions, and the criteria set forth in s. 672.54, the paramount consideration being the safety of the public, the mental condition of Ms. Hosein, her reintegration into society, and other needs of Ms. Hosein.
DATED this 20th day of February 2026, at the City of Toronto, in the Toronto Region.
Ms. C. Murray Legal Member Office of the Registrar Ontario Review Board