Re: Tesfaye Asefa
ORB File No: 5860
Hearing held on: Thursday, December 18, 2025
Place of hearing: Centre for Addiction and Mental Health
Pursuant to: Sections 672.81(1) & 672.81(2.1) of the Criminal Code
Before: Alternate Chairperson: Ms. S. Kert Members: Dr. T. Verny Dr. G. Nexhipi Hon. C. Nelson Mr. W. Apted
Parties Appearing: Accused: Tesfaye Asefa Counsel: Mr. A. Rai The person in charge of hospital: Counsel: Ms. M. Warner Attorney General of Ontario: Counsel: Ms. G. Meyers
REASONS FOR DECISION AND DISPOSITION
(Dated February 4, 2026)
Overview
On April 28, 2011, Tesfaye Asefa was found not criminally responsible on account of mental disorder on two charges of sexual assault. He is currently subject to a disposition that detains him on a general forensic unit at CAMH, with privileges extending to living in Toronto in accommodation approved by the person in charge.
On December 18, 2025, this panel of the Review Board convened a hearing at CAMH to review that disposition under s.672.81(1) of the Criminal Code. As the Review Board received notice in late July 2025 that Mr. Asefa had been readmitted to CAMH and continued to be detained for more than seven days, a restriction of liberty (“ROL”) hearing was also required. An earlier ROL hearing scheduled for September 25th was adjourned after Mr. Asefa went AWOL and did not return to CAMH until October 15, 2025. He remained in hospital as of the date of this hearing.
At the conclusion of the hearing, the parties jointly agreed that the significant increase in restrictions on Mr. Asefa's liberty (by his readmission on July 23rd) was necessary and appropriate when it occurred, and remained so at the time of the hearing. Further, the parties jointly submitted that the test for significant risk is met, and that the current detention disposition should continue for the coming year. The primary issue between the parties involved Mr. Asefa’s request for the addition of a privilege that would permit him to travel once (for no more than 24-hours) to Ottawa subject to an approved itinerary and accompanied by staff, to attend the Ethiopian Embassy and apply for a passport. While the Crown expressed some concerns about the proposed travel, CAMH did not oppose the request.
We agree with the joint position of the parties on the issues of the restriction of liberty and significant risk. We also find that the necessary and appropriate disposition is a continuation of the current detention disposition, with changes to include the addition of: i) the requested travel provision, as outlined above; ii) a requirement that Mr. Asefa deposit any passport(s) issued in his name with the person in charge of CAMH (or their designate) for safekeeping; and iii) a direction requiring that the person in charge safely keep any passport deposited by Mr. Asefa. These are our reasons.
Background and Index Offences
Mr. Asefa was 46 years of age at the time of the hearing, having been born in January 1979 in Ethiopia, the eldest in a sibling of six. He moved from Ethiopia to Nairobi in 2005, and immigrated to Canada in 2007.
Prior to the index offences, Mr. Asefa had no criminal record. He did, however, have some history of contact with psychiatric services. In September 2009, he was admitted to CAMH after being found unfit to stand trial on a charge of stealing food. He presented as grossly psychotic and was treated with high dose olanzapine. It took several weeks for him to respond to the medication. The discharge diagnosis was psychotic disorder NOS, possibly schizophrenia.
The index offences occurred in May 2010. On May 16, 2010, Mr. Asefa was at a TTC station when he approached a woman from behind and grabbed her buttocks. He was arrested, charged, and detained at the Don Jail. Three days later, while he remained in custody, Mr. Asefa sexually assaulted his cellmate by grabbing his testicles.
On May 31, 2010, Mr. Asefa was admitted to CAMH after being found unfit to stand trial in respect of the index offences. On admission, he presented as floridly psychotic. He was treated with olanzapine and his mental state improved. However, he continued to present with problematic behaviours, including sexually inappropriate behaviour.
The Review Board found Mr. Asefa fit in early July 2010, but his psychotic symptoms continued. Despite this, Mr. Asefa was returned to court in late July 2010, was found fit to stand trial and was granted bail a few days later.
At some point while on bail pending the resolution of the index offences, Mr. Asefa began living at a shelter in Toronto. In February 2011, he was charged with sexually assaulting a woman he met while living there. Mr. Asefa was arrested and held in custody on the charges. He remained incarcerated until he was found NCR on the index offences in late April 2011, following which he was detained at CAMH on a secure unit. In July 2012, he was convicted of the sexual assault charges from February 2011. He received a sentence of six months in jail and three years of probation, in addition to 17 months pre-trial custody.
In December 2013, Mr. Asefa was transferred to a general forensic unit at CAMH. With ongoing treatment his mental condition remained stable, but his use of cannabis on several occasions led to the suspension of his privileges and delays in discharge planning. In April 2015, he was discharged to semi-independent housing in the community.
While living in the community, Mr. Asefa struggled with abstinence, including cannabis, cocaine, crack cocaine and methamphetamine use. He was also frequently non-adherent with medication, and required multiple admissions to hospital for his decompensated mental state due to medication non-adherence and/or substance use. At times, his behaviour in the community was also problematic – in April 2018 he was admitted after staff at his residence reported that he had been observed naked in common areas of the residence, consuming alcohol, and other substances (including crack cocaine) and that on two occasions he attempted to kiss and/or touch a female staff member.
Starting in June 2018, there were also several serious AWOL incidents, including for 8 months between August 2018 and April 2019; for 6 weeks in May and June 2019; and for several days in January, February, and June 2020. In September 2020, Mr. Asefa was transferred to Waypoint as a consequence of the numerous absconding incidents over the previous two years.
Mr. Asefa did well at Waypoint. He was an active participant in substance use programming, did not engage in substance use, participated in a variety of CBT/DBT skills groups and presented no behaviour or management problems. However, his insight into his mental illness, substance use, and criminal behaviour remained limited.
At Mr. Asefa’s 2021 annual ORB hearing, the team at Waypoint expressed the opinion that he did not require the high security programs at Waypoint, and recommended a transfer to St. Joseph's Healthcare Hamilton (“SJHH”). The ORB agreed and ordered his transfer to SJHH, where he was admitted in December 2021. He remained at SJHH until October 2022, when he was transferred back to a general forensic unit CAMH, because of his familiarity with Toronto.
Shortly after his return to CAMH, Mr. Asefa was approved for community privileges. He attended multiple neighbourhood groups and was considered highly engaged. On January 18, 2023, he did not return from a community pass. He went to a nearby bank, withdrew all of his funds and purchased and used crack cocaine. He returned to CAMH two days later when he ran out of money.
Mr. Asefa’s progress thereafter was slow but steady. At his annual hearing last year, his (then) psychiatrist Dr. Woodside advised that Mr. Asefa had a positive clinical year, with no incidents of elopement, substance use or management problems. Dr. Woodside also testified that while medication adherence was a concern, the greater risk for Mr. Asefa is his potential return to substance use, which would likely have a more pronounced and rapid effect on his mental status than medication non-adherence alone.
Course Since Last Hearing
At the current hearing we received evidence in the form of an updated hospital report, as well as oral testimony from Dr. Igoumenou, Mr. Asefa’s psychiatrist since April 2025. That evidence revealed as follows: In hospital, Mr. Asefa continued to progress well. His mental state remained stable, and he used his passes appropriately. All urine drug screen (“UDS”) results were negative, apart from one; he tested positive for ephedrine/pseudoephedrine on September 12, 2024, but explained that he had taken Benadryl.
On April 22, 2025, Mr. Asefa was discharged to live in the community in supportive housing with 7-day a week on site support. At least initially, he continued to take his medications, provided regular UDS samples and met with his Forensic Outpatient Service (“FOPS”) team as required. He presented at his psychiatric baseline, with no residual psychotic or mood symptoms.
By June 17th, however, Mr. Asefa tested positive on a UDS for cannabis and cocaine. When confronted, he told FOPS staff that he had used cannabis, crack cocaine and crystal methamphetamine. His mental status was stable. He continued using substances but also maintained medication adherence, and his mental state remained stable. He reported that he was motivated to stop using drugs, and on July 9th, voluntarily attended at the CAMH Emergency Room. He was not a candidate for the medical withdrawal service and was discharged to attend a non-medical detox unit.
On July 12, Mr. Asefa self-admitted to a non-medical detox unit run by Withdrawal Management Services of Toronto. He stayed there for the maximum number of days allowed, and on his own initiative found another non-medical detox facility where he moved on July 20, 2025. The following day he left the facility and did not return. He used crack and crystal meth, and failed to respond to calls from his case manager until late in the day on July 22. He attended a review at the FOPS office on July23rd, and reported that he stayed at his drug dealer’s place and missed one dose of his medications. He walked with his case manager to CAMH ER and was admitted.
In hospital, Mr. Asefa attended both individual and group sessions related to substance use prevention. His mental state remained unchanged. He progressed up the privilege ladder, used his passes without incident and provided negative UDS. In mid-September he was granted indirectly supervised community passes. On September 23rd, during a meeting with the FOPS team planning his discharge from the inpatient unit (including Dr. Igoumenou), he said that he was “doing well.” Later that same day, he went AWOL while on an indirectly supervised pass.
The following day, staff were able to contact Mr. Asefa by phone. He said that he had found a pipe while cleaning his room, couldn't control his cravings and “used meth." Although he agreed to return to the unit, Mr. Asefa did not return to CAMH until the night of October 15th. He self-presented at the ER and was admitted to the Psychosis Unit under the care of Dr. Ginsberg, the same unit he had been on before going AWOL.
Although the doctor who assessed Mr. Asefa in the ER did not observe any major evidence of decompensation, Dr. Ginsberg did notice some changes in his mental state upon his return – Mr. Asefa made some bizarre comments about religion, his mood was a bit elevated, and he was more elated than at baseline. He did not have his medications with him while AWOL, and he used drugs and stayed at friends’ houses while away from the hospital.
In early November, Mr. Asefa was transferred to a general forensic unit, where he has remained since that time. He has been compliant with treatment recommendations and his mental state has settled back to baseline. He continued to test positive for cannabis until November 26th, but the team is aware than he is a slow metabolizer and there has been no evidence of drug use in hospital. By the time of the hearing, he had begun to use passes on the hospital grounds, without incident.
In addressing Mr. Asefa’s request for a one-time pass to attend the Ethiopian Embassy in Ottawa, Dr. Igoumenou said that while there is always a concern about the unpredictability of Mr. Asefa going AWOL, the team is aware that he is an only child, he has not seen his mother (who lives in Italy) in two decades, and he is very keen to see her, particularly as she is aging. This is something that Mr. Asefa has talked about for some time, long before his recent AWOL and return to hospital. The doctor described such a trip as “aspirational” for Mr. Asefa.
Analysis and Conclusion
Based on the evidence, the threshold test for significant threat is met. Mr. Asefa's risk flows from his major mental illness, bipolar disorder, as well as his polysubstance use disorder which, acting together and separately, have driven his sexually assaultive and sexually inappropriate behaviours in the past.
Although currently compliant, Mr. Asefa has a history of non-adherence with treatment when less closely supervised. Perhaps more concerningly (given the events of the past year), at this time Mr. Asefa remains at high risk for AWOL, relapse to substance use and resulting decompensation, absent the protective environment of the hospital, and the monitoring, support and supervision provided under a disposition. As described in the hospital report, “in such situations his risk would be actualized, with Mr. Asefa engaging in physically or sexually violent behaviours such as those at the time of the index offences.”
On the question of the restriction of liberty, we are satisfied that both the initial decision (in mid-July 2025) and the ongoing decision (to the time of the hearing) to increase restrictions on Mr. Asefa’s liberty were necessary and appropriate and remained so throughout. Despite evidence and statements from Mr. Asefa that he had returned to substance use, in June and early July 2025, the treatment team worked hard to try to keep him in the community. Ultimately, however, both he and the team determined that an admission was necessary to interrupt his substance use and manage his risk, and Mr. Asefa cooperated with an admission on July 23rd.
In hospital, Mr. Asefa made progress. He returned to his baseline, exercised passes (including back to his residence) and was able to abstain from substance use for several weeks. Given this progress, plans were in place to discharge him back to his housing after his scheduled ROL hearing on September 25. That never happened. Instead, on September 23rd, Mr. Asefa went AWOL, relapsed to substance use and remained in the community until his return on the night of October 15th.
Since that time, Mr. Asefa has continued to be detained as an in-patient in hospital. He has been restabilized on medication and has described a commitment to working with the treatment team to get back on track. Dr. Igoumenou explained that the focus for the team for the foreseeable future is to address Mr. Asefa’s risk of relapse to substance use by re-engaging him in therapy while he remains in hospital, but also by ensuring that he has more structured activities (educational, vocational) and prosocial contacts in place before discharge back to his community housing can be contemplated (his housing remains available to him). While Mr. Asefa does understand that substance use has prohibited him from moving forward in life, the difficulty for him has been following through with his plan to maintain abstinence for the long-term. The team’s hope is that this new approach will assist him in being more successful in achieving this goal.
Finally, we agree that the current detention disposition remains necessary and appropriate to allow Mr. Asefa to move forward in the coming year. The ability of the hospital to approve his accommodation ensures that once he is ready for discharge, Mr. Asefa’s housing is appropriate to support his stability in the community. The warrant of committal associated with a detention disposition ensures that he can be returned to the hospital quickly and before he meets criteria for involuntary admission under the MHA, should that be necessary.
We have also included the narrow and circumscribed travel provision requested by Mr. Asefa. Mr. Asefa has long expressed the goal of seeing his mother, and he cannot do so without a passport. Dr. Igoumenou said that Mr. Asefa had informed her that to obtain a passport, he has to deposit his application in person at the Ethiopian Embassy in Ottawa, though the team has yet to verify that this is the case. She also testified that a trip to see his mother is “aspirational” for Mr. Asefa, meaning it will give him something to work toward. A trip to Ottawa will occur only at the discretion the person in charge and subject to an approved itinerary, and only if the team is convinced that it is necessary to enable Mr. Asefa to successfully obtain a passport. To guard against any AWOL concerns associated with Mr. Asefa having a passport, he will be required to deposit any passport issued in his name to the person in charge of the CAMH or their designate.
DATED this 4th day of February, 2026, at the City of Toronto, in the Region of Toronto.
Ms. S. Kert Alternate Chairperson
Office of the Registrar Ontario Review Board