Re: A. (M.)
ORB File No: 6694
Hearing held on: Thursday, April 9, 2026
Place of hearing: Centre for Addiction and Mental Health
Pursuant to: Section 672.81(1) of the Criminal Code
Before:
Alternate Chairperson: Ms. C. Fromstein
Members: Dr. J. Kis Dr. A. Kerry Hon. N. Kozloff Mr. S. Doherty
Parties Appearing:
Accused: A. (M.) Counsel: Mr. G.P. Jones
The person in charge of hospital: Counsel: Ms. G. Meaney, Articling Student
Attorney General of Ontario: Counsel: Mr. D. Brandes
*Pursuant to s. 672.501(1) of the Criminal Code, the Ontario Review Board prohibits the publication, broadcasting, or other transmission of any information that could identify a victim in this matter or a witness who is under 18 years of age.
REASONS FOR DISPOSITION
(Dated May 13, 2026)
Introduction
On January 27, 2015, A. (M.) was found not criminally responsible (“NCR”) on account of mental disorder on charges of sexual assault (x2), contrary to the Criminal Code of Canada. He is currently subject to a Disposition dated May 7, 2025, discharging him on conditions.
On April 9, 2026, this panel of the Board convened at the Centre for Addiction and Mental Health, Toronto (“CAMH”) to conduct the annual review of A. (M.)’s Disposition.
Position of the Parties
At the outset of the hearing, the parties were canvassed as to their initial positions. Ms. Meaney, on behalf of the hospital, indicated the hospital’s position that A. (M.) continues to represent a significant threat to the safety of the public and that the necessary and appropriate Disposition is a continuation of the current conditional discharge with the addition of a residence clause requiring that A. (M.) reside at 1908 – 400 Webb Drive, Mississauga.
Mr. Brandes, on behalf of the Crown, joined that position.
Mr. Jones, on behalf of A. (M.), indicated that he joins the position that a conditional discharge continues to represent the necessary and appropriate Disposition; however, he does not agree with the addition of the residence clause. He seeks to amend the clause in the current Disposition that requires A. (M.) to notify of an intention to move to be changed to “notify within 60 days of an intention to move or an actual move”. Mr. Jones noted that he felt it was unlikely that his client would move from the family home.
Index Offences
- The circumstances of the index offences are set out in last year’s Reasons for Disposition as follows:
“Briefly, both incidents occurred on September 6, 2013, on the property of Sheridan College Hazel McCallion Campus, located in the City of Mississauga. The accused and the victims were not known to each other. During the afternoon hours, the accused was in the computer lab in order to access Facebook. KP, a third-year student, was working there as a co-op student. She was assisting another student with an issue when the accused, who was seated nearby, reached out with the middle finger of his hand and touched the victim's vagina over her clothes. The victim immediately removed herself from the area.
Later the same day, the second victim, a professor at the College, was walking through the campus hallway when the accused stepped in front of her blocking her path. He grabbed the victim in her private area. The victim pushed the accused's hand away, immediately left the scene and contacted security.
When the accused was arrested, he advised police that he liked to touch women he did not know in an attempt to arouse them and that he had been involved in similar incidents.”
Evidence at the Hearing
The evidence at the hearing was comprised of the Hospital Report, Exhibit 1, and the testimony of Dr. Meng.
A. (M.)’s personal history is detailed in the Hospital Report and need not be repeated here. Briefly summarized he is currently 27 years of age. He was born in Libya, and he does not have Canadian citizenship. He has been granted ODSP with funds for medication, but the Hospital Report noted that he cancelled his coverage. The hospital was previously supplying medication on compassionate grounds. He has been advised that a community doctor will not treat him if he does not have OHIP, which would hamper his being granted an Absolute Discharge in the future.
His diagnoses are Bipolar Disorder Type 1 and Narcisstic Personality Traits.
In 2022 he showed rapid deterioration even while taking his oral medication. He became more grandiose with religious and sexual preoccupations. He assaulted his brother and father, and it required that the police taser him on arrest. He was readmitted to Hospital in May and required seclusion. By August 2022 he stabilized.
A. (M.) is currently receiving medication by injection every four weeks. He has been preoccupied by his belief that the medications are causing him sexual dysfunction, and he seeks to change medications.
Dr. Meng, who is A. (M.)’s outpatient psychiatrist, testified She noted that her discussions with him regarding medication are ongoing but circular. His parents, who are A. (M.)’s Substitute Decision Makers (“SDMs”), have recently indicated that they are open at this time to him transitioning back to oral medication but with the clear understanding that if there are any signs of mental deterioration, they will contact the team and notify the police.
A. (M.) has said that he will take medications as prescribed which the team finds credible given that historically he is a man of his word. There have been prior concerns regarding his compliance on oral medication even though he had intended to comply but because of gastric issues there was unintentional noncompliance.
Dr. Meng expressed ongoing concerns that there must be a safety plan in place. She indicated that his insight into the need for treatment has not changed in years. He remains adamant that he does not want to be on medication. He feels that this impedes his quality of life and prevents him from achieving his future goal to get married and have sex within the marriage. A. (M.) believes that his medications prevent that. Dr. Meng indicated that the treatment team’s impression as well of those of his parents are that there is no type of medication that will satisfy his concern about the sexual side effects from medication. Despite his views, he has remained compliant.
Dr. Meng expressed that A. (M.)’s thoughts about his sexual functioning are not realistic; he compares his current sexual functioning to that of his early 20s when he was hypersexual as a result of his manic symptoms. He feels his current sexual functioning is inadequate. Dr. Meng does not believe that there is any medication regimen that will dissuade him from this view.
At the end of the last year, A. (M.) had a consultation with MAPS regarding their medication recommendations for someone (like himself) who does not tolerate his current medication well. There are medications that may be prescribed to manage the side effect he has complained of. Dr. Meng says that she has ongoing discussions with A. (M.) at every one of his monthly appointments. He is fixated on medications and on changing them. The discussions are circular, and his opinions have not changed. Despite his views he attends his appointments and is compliant with his medication.
When asked what role the Board Disposition plays in his compliance, she noted that A. (M.) is quite rigid, very ethical and law abiding. He reportedly does not lie. That is why Dr. Meng believes what he says. He will follow explicitly stated rules which is the reason why it is so important that the Disposition clearly states what is required of him, including with respect to the residence. His reluctance to stay on medication has been a source of conflict with his parents. He took steps to move out of the family residence in October 2025. At that time, he did not tell anyone until just before he was about to move. His mother notified the treatment team. A. (M.) had put a down payment on an apartment which he ultimately lost when he did not move.
A. (M.) told Dr. Meng that he did not have the funds to pay for both rent and food and his plan had been to go to the food bank after the move. He reported that he would use his tax refunds and savings to pay his rent as he did not otherwise have funds to do so. He speaks about his long-term plan as divine intervention supporting him. Dr. Meng noted it would be a very precarious situation if he moved out.
Dr. Meng testified that if A. (M.) discontinued his medication his parents would insist that he move out, and he would feel the need to do so. The residential clause keeps him within a stable environment and helps encourage medication compliance. This is particularly important if he transitions to oral medication. His parents differ in their interactions with A. (M.) in this regard. His mother’s thought is that a threat to make him move out of the home is not effective. In the past he has left and been mentally unstable living on the street. In contrast, his father feels that threatening to remove his son from the home will encourage him to adhere to his medication and remain in the residence. Both parents prefer that A. (M.) reside with them while taking his medication.
Dr. Meng testified that it is the team’s opinion that the residence clause will keep A. (M.) stable which view is shared by his family. Were A. (M.) to obtain his own residence it is likely that it would not be adequate to maintain his stability. The likelihood of his moving is fairly low because if he is compelled to take treatment, he will be unlikely to move out. If there was nothing legally prohibiting him from moving out, he might take that opportunity.
Dr. Meng testified that it is necessary and appropriate that the Disposition set out the address of the family residence in which he must reside. If he moved out, he would likely be precariously housed, not able to afford food and become partially medication noncompliant. All the protective factors for him are external and his living situation is a significant factor with respect to his ongoing stability. It is what has assisted him to remain living in the community. After he was admitted to hospital a few years ago his discharge to the family home gave him stability. If he were not to live there, he would lose that protection. His parents remain his primary social network and are prosocial influences.
A. (M.) is well educated and underemployed with his educational background. His illness makes him quite rigid.
Regarding goals for the upcoming year, Dr. Meng said it is hoped that the team is able to find a solution that is mutually acceptable with a medication regimen that A. (M.) can accept on a long-term basis. She noted that this is a very optimistic outlook. The ultimate goal is that he can reconcile to being on medication long term.
In response to questions, Dr. Meng indicated that the effects of medication on his sexual abilities are not delusional. There is a reality-based foundation for some concern in that he has a low testosterone level for someone his age and some erectile dysfunction. However, the impact of the hormone levels is not significant. One would expect some impact from the medication but not to the profound degree that he states. A. (M.) is very reluctant to explore other possible factors. In the past treatment year, the Hospital Report noted that A. (M.) agreed to some testing by an endocrinologist and those results remain pending. He said he did the blood work but there is nothing available and there has been no follow up.
His expectations regarding his sexual functioning are unrealistic. He was quite hypersexual in his early 20s. Now he is older. A. (M.) believes that not experiencing erections when seeing women in public is an indicator of his sexual functioning. Dr. Meng testified that is not realistic and not appropriate, but these are the markers that he considers when deciding if his sexual functioning is adequate.
Regarding the possibility of a change from injectable to oral medication Dr. Meng noted that even perfect compliance with oral medication does not provide the same protection as long-acting injectable medication. Persons receiving oral medication as opposed to injectable medication have a seven times higher relapse rate. If he continues to reside with his parents, they can monitor his mental state and advise the team of any change. Until he becomes quite unwell A. (M.) is rule abiding and will show up for appointments so he would likely be certifiable were there a decline in his mental health. When he had his last readmission, he presented at the hospital the day before. Dr. Meng stated her opinion that he could continue to be managed on the conditional discharge on an oral medication if he was residing with his parents. This would be a key factor if he was transitioned to oral medication. In 2022 when the assault event took place on his brother and father that resulted in his readmission, he had been overtly noncompliant with medications.
Dr. Meng was asked questions by A. (M.)’s counsel concerning his earlier years following the onset of his mental disorder. She noted that he had better functioning for years because he was treated but he was involved in many instances of concerning behaviour before the index offence. It was noted that in 2008 he moved to Vancouver and lived on park benches and was transient.
A. (M.) is well educated and does not suffer from any intellectual deficit. His religious beliefs inform his poor appreciation of medications, but these beliefs themselves are informed by his illness. His parents indicate that his religious beliefs do not align with their cultural beliefs or how he was raised. His are idiosyncratic and he has odd interpretations including that if he stops taking medication his religion will take care of him.
When asked about A. (M.)’s views of the index offence, Dr. Meng indicated that he has acknowledged that his actions were inappropriate, but he did not think they were serious.
Dr. Meng commented on the gains and socialization that A. (M.) has made recently. Dr. Meng stated that overall A. (M.)’s functioning has gradually improved since his discharge from hospital and the optimization of his medication. He is more able to establish social rapport and has been less guarded than in the past. He was extremely socially isolated previously; his functioning has improved. Dr. Meng expressed a concern that medication changes will result in him losing some of that. She noted that it will still likely manage his risk but not be as positive for his quality of life. The discussion with respect to medications will need to be held in the future with A. (M.) and his substitute decision makers.
Dr. Meng was asked about whether A. (M.) continues to have OHIP which was an issue at the time of last year’s hearing. She testified that he did not get rid of his OHIP, but it was expiring, and he indicates that he will not be renewing it, although he oscillates. Were he to no longer have OHIP, this would be a barrier to him being transitioned to a civil team. In the past he was fired from such a team because he refused to renew his health card. A. (M.)’s reluctance to accept any government assistance puts a financial strain on the family.
Dr. Meng, in response to questions, indicated that because of the affective component in his illness, he can fluctuate with respect to risk of violence when unwell. A trigger can result in an explosive outburst. His potential for violence can occur rapidly. Dr. Meng was clear that A. (M.) will not fair better on oral medication and is something that is discussed every month. One difficulty is that he will request a certain dosing of medication, such as requesting 50 mg when the doctor indicates that 400 mg is the minimum appropriate for him. He will become fixated on a number, and it becomes a circular discussion. His parents remain firm that he must agree to the proper course of treatment, or they would not otherwise agree to the change to oral medication. Remaining on injectable medication would be the more prudent approach to manage his risk. Based on this Dr. Meng was asked whether it would be unlikely that he will in fact be switched to oral medication and she noted that this will be a matter for further discussion noting that it will be hard to rationalize that the benefits of oral medication outweigh the risks. If he is residing in the community and he was to transition to oral medication she agreed that they would have to reactivate his community treatment order.
Dr. Meng was asked about his sexual risk assessments and whether the team is considering using measures to assess his current dynamic risk factors. The last actuarial sexual risk assessment was done in 2015. Dr. Meng indicated that she does not believe this is the most effective way to assess his risk management. His propensity for sexual recidivism is actuarily quite low, he is not antisocial, has not used substances and does not have a diagnosis of paraphilia. The one factor with respect to his risk is that when he is ill, he becomes hypersexual and then there is a very high risk in that context for him re-offending sexually. He has unrealistic expectations with respect to sexuality. A. (M.) was engaged in individual therapy in the years 2022 to 2023 with little benefit because of his extreme rigidity due to the symptoms of his illness.
With the more recent improvement of his symptoms with medication, some of his specific rigid views have slightly shifted to the point that he now says he will sometimes watch sexual material. However, any time that the team tries to challenge his beliefs he gets quite defensive and remains quite fixed.
Dr. Meng was asked whether A. (M.) shows remorse for his offences noting in the Hospital Report that has minimized them in the past. She testified that he recognizes that his behaviour was not appropriate though he has never specifically said that he feels badly.
A. (M.) testified. He described some of his religious views with respect to his illness and treatment. He stated that his religion sets out that wanting to restrict a man’s erection by giving him medication until he is sick forever and forever dependent on doctors is an abuse of the religious rule and that the person will go to hell. A man who does not know the truth does not know what the medication does, just takes it and he noted that Mohammad forbade staying away from life’s pleasures and dictated that you must marry and enjoy sex with your wife. Responding to the questions about remorse, A. (M.) stated that it is only Allah who forgives and that he repents on his own. His quitting pornography had been an expression of his remorse. He feels that his return to masturbation in moderation will prevent him from re-offending, though if he did so daily, he would re-offend. He expressed that he is fixated on sex. If he cannot have sex, then there is no point in getting married. A. (M.) stated that the medication is impacting his physicality and is disabling him. He used to make money doing general labour, but the medication has made him “physically weak,” negatively impacting his ability to work.
Submissions
Ms. Meaney, on behalf of the hospital, congratulated A. (M.) for his relative stability and his continued attendance for meetings with his treatment team. Despite his reluctance to take medication. A. (M.) has remained compliant and has remained living with his parents, both of which are positives. The team is concerned with A. (M.)’s clear statement that he does not want to be taking medication. This is a source of conflict with his parents. His parents want him to stay at their home, but a barrier will be created if he stops taking treatment. The hospital’s position is that it is an integral part of his risk management that he reside with his parents. This ensures medication compliance and maintains him in a supportive and stable environment. She submitted that all the evidence is that A. (M.) is rule abiding and will follow rules as they are written. For this reason, the residential clause is necessary and appropriate to be included in his conditional discharge.
Mr. Brandes, on behalf of the Crown, noting that it is the externality of protective factors that keep A. (M.) well and which manage his risk. If left to his own choices, there is a likelihood that he would pose a risk to the community in a sexual way. The nature of his preoccupation about sexuality is abundantly clear. The residential clause is a key factor in maintaining his stability and the safety of the community while he is on a conditional discharge Disposition.
Mr. Jones, on behalf of A. (M.), maintained his position opposing the inclusion of the residential clause. He varied his initial position to ask that the Disposition remain the same rather than extending the time period for notification of a move of residence. He noted that there is evidence that his client recognizes his prior behaviour was inappropriate. Mr. Jones asked the Board to consider that his client has made significant gains in terms of socializing and being actively involved with other people in deciding about the necessity for the residential condition.
Analysis and Conclusion
The Board is unanimous in finding that A. (M.) represents a significant threat to the safety of the public. We rely on the evidence of Dr. Meng which we accept and the Hospital Report in so finding as well as noting the joint position of the parties. If untreated, A. (M.) would likely decompensate and experience manic symptoms and aggressive and/or sexually inappropriate behaviour. This has been demonstrated both by the index offences and his more recent behaviour in 2022 when he assaulted family members and a police officer and had to be tasered and then ultimately placed into seclusion.
The conditional discharge has been effective in managing A. (M.)’s risk to the community while he has been medication compliant. The Disposition remains appropriate. A. (M.) on the evidence is someone who adheres to the written rule. His motivation to remain treated for his disorder is entirely external and he continues to express his strong views that the medications harm him and he does not wish to take any medication. Without the Disposition there is a clear risk that A. (M.) would fall away from treatment and would likely refuse any psychiatric care. This would lead to a rapid decompensation in his mental state with a resurgence of his psychotic and manic symptoms. He would be very likely to engage in sexual aggression against women as well as potentially physical aggression towards family members or others.
There is the potential plan moving forward that A. (M.) might be transitioned from his current injectable medication to oral medication. His substitute decision makers, his parents, have agreed to this if A. (M.) agrees to take such medication as prescribed. Dr. Meng in her evidence was clear that A. (M.) remains fixated on taking a lower dose and that their monthly discussions are circular.
A. (M.)’s evidence at the hearing also made clear his concerns that medication harms him as well as his fixation on sexuality. Residing with his parents provides him with a stable and prosocial environment. Importantly, his parents are quite involved and keep a close watch on him. If he were to transition to oral medication this would be even more important so that his medication compliance could be monitored.
Despite the evidence that A. (M.) abides by rules, there is also evidence that he has in the past been noncompliant, not intentionally but due to other issues. It remains unclear whether a transition to oral medication will take place in light of the evidence before us. His residing with his parents is a key factor that permits him to remain on a conditional discharge and for that Disposition to successfully manage his risk. It is unquestionable to the Board that residing at his current address must be a condition of his Disposition, particularly in light of the actions he took last year towards moving out of that residence.
For these reasons, we accept the positions of the hospital supported by the Crown for a continuation of the conditional discharge with the added residence condition.
We appreciated A. (M.) giving evidence to the Board and expressing his views. We commend him on his adherence to his Disposition and attending meetings with this treatment team.
We make this Disposition in consideration of the primary factor, protection of the safety of the public, A. (M.)’s mental condition, his reintegration into society and his other needs.
DATED this 13th day of May, 2026, at the City of Toronto, in the Toronto Region.
Ms. C. Fromstein Alternate Chairperson
Office of the Registrar Ontario Review Board