Re: Joe P. Emmanuele
ORB File No: 7840
Hearing held on: Tuesday, May 12, 2026
Place of hearing: Southwest Centre for Forensic Mental Health Care 401 Sunset Drive, St. Thomas
Pursuant to: Section 672.81(1) of the Criminal Code
Before: Alternate Chairperson: Mr. J. Weinstein Members: Dr. R. Kunjukrishnan Dr. P. Wright Mr. E. Siebenmorgen (by Zoom videoconference) Ms. B. Little
Parties Appearing: Accused: Joe P. Emmanuele Counsel: Ms. K. Bhamra
The person in charge of hospital: Counsel: Ms. J. Zamprogna
Attorney General of Ontario: Counsel: Ms. K. Dalrymple
REASONS FOR DISPOSITION
(Dated June 3, 2026)
Introduction
On January 20, 2021, Joe P. Emmanuele, now 32 years of age, was found not criminally responsible on account of mental disorder (NCR) on one count of attempted murder, contrary to the Criminal Code. Mr. Emmanuele was most recently subject to a Disposition of the Ontario Review Board (“ORB” or “the Board”) dated May 21, 2025, detaining him at the Southwest Centre for Forensic Mental Health Care (“Southwest Centre”, “SCFMHC” or “the Hospital”), with privileges up to and including entering the community accompanied by staff or an approved person, and monthly 12-hour accompanied passes into Southern Ontario. The Disposition also makes provision for attending a residential treatment program for up to 90 days.
On May 12, 2026, a panel of the Board convened to review Mr. Emmanuele’s Disposition pursuant to s. 672.81(1) of the Criminal Code. He was present for his hearing and represented by his counsel, Ms. Bhamra, throughout. The issues for determination at the hearing were whether Mr. Emmanuele represents a significant threat to the safety of the public, and if so, the necessary and appropriate Disposition to manage that risk having regard to the criteria set out in s. 672.54 of the Criminal Code.
The evidence for the hearing consisted of the Hospital Report, dated March 18, 2026 and the oral testimony of Dr. A. Malka, Mr. Emmanuele’s attending psychiatrist.
When parties were canvassed for their initial, tentative positions at the commencement of the hearing, counsel for the Hospital submitted that Mr. Emmanuele remains a significant threat to the safety of the public and that there should be no change to the current Disposition, other than the following:
- a geographical expansion of Mr. Emmanuele’s accompanied privileges to encompass both Southwestern and Southern Ontario; and
- the specification of both “Southwestern Ontario” and “Southern Ontario” as the geographical limits of Mr. Emmanuele’s monthly 12-hour accompanied passes.
Counsel for the Attorney General and counsel for Mr. Emmanuele both supported the Hospital’s recommendation. Thus, the panel was presented with a joint submission.
Notwithstanding the joint position of the parties, it is the panel’s duty to independently satisfy itself that Mr. Emmanuele represents a significant threat to the safety of the public. Following deliberations, the panel made that finding. The panel further accepted the joint position and found that the necessary and appropriate Disposition, representing the least onerous and least restrictive option in the circumstances, is a Detention Order on the terms and conditions found in the May 21, 2025 Disposition, with the modifications noted above.
Index Offence
- The circumstances of the index offence are taken from the Hospital Report and reproduced in last year’s Reasons for Disposition as follows:
"At 7:37 on October 17th, 2020 at [address redacted], Fergus, the accused, Joseph Emmanuele, born October 11th, 1993, entered the victim’s bedroom and stabbed her in the back of the head. The victim, Mishell Emmanuele, born [redacted],1961, is the mother of the accused. After stabbing the victim, the accused called 911 and advised that he had to kill his mother and that she is not doing well. The accused was located outside of the house, covered in blood, and placed under arrest.
Injuries: The victim was taken to Groves Memorial Hospital with deep puncture wounds to the rear left of her head and multiple stab wounds to the left side of her head.”
- Mr. Emmanuele is a relatively young man, being 27 years old at the time of the index offence. He is single and has no dependents. His history and background leading to the time of the offence are described in detail in the Hospital Report, and as the Report is in evidence, this information need not be extensively reviewed here. Those aspects of his history that are of particular importance were summarized in previous years’ Reasons for Disposition and are reproduced here:
In brief, he is one of two sons born to his parents, who separated when Mr. Emmanuele was approximately seven years old. His brother, who is older, reportedly also has a major mental illness and resides in a group home. Mr. Emmanuele has lived with his mother all his life, up to the time of the index offence, though has visited with his father. Mr. Emmanuele has no employment history and has been supported by ODSP benefits since the age of 18.
Mr. Emmanuele has an extensive psychiatric and substance use history, as detailed in the Hospital Report. He began to use cannabis in Grade 9. He started to show symptoms at age 14 and left school in Grade 10. He later tried to resume, earned several credits, but ultimately left again.
Mr. Emmanuele has a limited criminal history, having been conditionally discharged on a single count of assault. In addition to this limited record, Mr. Emmanuele has a significant history of violence and antisocial behaviour that spans approximately 13 years prior to the index offence. Many of his psychiatric hospital/medical admissions were due to his violent and aggressive behaviour. That behaviour has included: spitting in staff’s face, punching walls, breaking windows, yelling violently and screaming obscenities, making threatening statements, hitting and pushing his mother, damaging property, assaulting a nurse, throwing his crutches across a room, and “trashing” his basement.
At age 15, Mr. Emmanuele was admitted to Brampton Civic Hospital as an involuntary patient after experiencing auditory hallucinations and paranoid thoughts. He was aggressive with staff and had to be secluded. He was in hospital for approximately three weeks. His discharge diagnosis was psychosis not otherwise specified, with a differential diagnosis of schizophreniform disorder and schizophrenia.
The Hospital Report indicates that Mr. Emmanuele was being followed in the community by an ACT team by at least the first half of 2011, as in June of that year he was brought to hospital by an ACT worker after breaking a window in the ACT office. He reportedly was experiencing hallucinations. There were increasing reports by his mother of assaultive and threatening behaviour towards her. Mr. Emmanuele also assaulted a staff worker at a respite home, and a nurse during one of his hospital admissions that year. He continued to experience hallucinations and was acting on them, but there was also discussion during this period about there being a volitional component to his aggression.
There were very few psychiatric admissions between 2012 and 2020 (the year of the index offence), with one in each of 2015 and 2016. Mr. Emmanuele was reportedly agitated, threatening and aggressive (in the form of property destruction) prior to each admission. The Hospital Report contains little information as to his behaviour and course of treatment in the community (if any) during this eight-year interval. In 2020, there is an indication that he was being followed by an ACT team in the community of Fergus, but it is not clear when this relationship began. His mother reported that Mr. Emmanuele spent his days “drinking coffee, smoking cigarettes and panhandling.” She reported that he panhandles “all day and night” and was banned from several establishments due to customer harassment.
Mr. Emmanuele’s cannabis use reportedly increased in 2020, particularly in the summer. He also had six reported hospital visits and/or admissions between June 4 and October 7. He spent prolonged periods at Homewood Health Centre, with briefer periods at other hospitals or in the community. After spending most of July and all of August of 2020 at Homewood, he was transferred for further stabilization to Grand River Hospital on September 7 and remained there until his discharge on October 7. He presented with hallucinations, paranoid delusional ideation concerning his mother, his psychiatrist, police, and his medications. He was agitated, not sleeping well, aggressive and increasingly threatening toward his mother, and while in hospital in August, became aggressive toward other patients.
Mr. Emmanuele was seen by his ACT worker and a new doctor on October 9, 2020, following his discharge from hospital two days earlier. Mr. Emmanuele reported that he was doing well since his discharge and felt that he had improved. He had quit smoking while in hospital and had quit using cannabis. He reported getting along well with his mother and had no concerns. He reported being compliant with his medications and feeling that they were helpful. His diagnoses were described as “schizoaffective disorder, bipolar type, multiple episodes currently in partial remission – no acute safety issues; cannabis use disorder – in early remission; tobacco use disorder, in early remission.” He was to follow-up with psychiatry in 3 months. The index offence occurred on October 17, eight days later.”
Course Since the Index Offence
Mr. Emmanuele was assessed for criminal responsibility at Waypoint Centre for Mental Health Care (“Waypoint”) and was admitted there following the NCR verdict. He was admitted to the Southwest Centre on May 4, 2021, and has remained there since. At Waypoint, he was described as a quiet and meek individual who presented with no management or behavioural issues. He was, however, actively psychotic, experiencing hallucinations and talking to himself. He was described as expressing remorse over the index offence. He was compliant with his prescribed antipsychotic medication.
Mr. Emmanuele continued to present with active hallucinations, along with delusional and paranoid thoughts, after his admission to the Southwest Centre. He described his hallucinations as coming from a single male voice and felt that it was like a constant battle or “internal war”. He reported getting stronger at “fighting back” and described a struggle of “fighting off the man” that he felt was inside of him. He was referred to psychological services by his treatment team due to what is described as an urgent concern for his well-being. He attended 14 sessions with a psychologist from May through August of 2021. The focus of treatment was (1) stabilization by increasing Mr. Emmanuele’s coping skills, incorporating Cognitive-Behavioural Therapy (CBT) and compassion focused strategies, and (2) processing his thoughts and feelings regarding the index offence as part of his journey to self-forgiveness. He was described as extremely dedicated to the therapeutic process.
Mr. Emmanuele’s degree of insight into the index offence, his mental illness, his medication, and his substance use as a risk factor is described as developing during his first two years at the Hospital. He remained compliant with his medication and took additional medication on an as-needed basis to cope with feelings of anxiety and worry.
During previous reporting years, Mr. Emmanuele continued to experience positive symptoms of his mental illness, including paranoid and persecutory delusions. These symptoms persistently impacted him, and he often demonstrated bizarre behaviours. He also expressed persistent auditory and visual hallucinations. He gradually became more open to discussing these with staff than he had been in the past. The voices were occasionally commanding in nature.
In other reported incidents from previous years, Mr. Emmanuele was observed to be glaring, irritable, clenching his fists and pointing at staff. He also demonstrated impulsive behaviours, which startled peers and staff around him at times, such as loudly clapping his hands and crying out loud. He generally managed to cope with the voices he was hearing by taking as-needed medication or by listening to music through headphones that he wore much of the time. He expressed violent intent in response to the hallucinations by stating that he had thoughts of harming others. In a manner reminiscent of the index offence, on July 31, 2023, he said that the male voice was telling him to “stab somebody”.
Evidence of Dr. Malka
- Dr. Malka has been Mr. Emmanuele’s attending psychiatrist since December of 2024 when she took over his care from Dr. N. Mokhber. She adopted the Hospital Report, provided an update, and elaborated on certain of its contents. Mr. Emmanuele’s diagnoses are reported as follows in the Hospital Report:
- schizophrenia, complicated by excited catatonia; and
- severe cannabis use disorder, in forced remission in a controlled environment.
Dr. Malka explained the meaning of excited catatonia and described its significance for Mr. Emmanuele. She stated that the condition is similar in its etiology to stuporous catatonia, which is what most people tend to picture as a person being very still and not speaking. With excited catatonia, the person may still have difficulty communicating but instead of sitting still, they would be pacing, engaging in purposeless movements and expressing nonsensical vocalizations. It is essentially an extreme state of anxiety.
Dr. Malka stated that as a result of adequate treatment, Mr. Emmanuele has been able to communicate what his internal experience has been. In her opinion, the condition resulted from a combination of his ongoing derogatory hallucinations, his experience of shame and guilt over his index offence, and, over the past year, obsessive-compulsive symptoms related to his treatment with clozapine. Such symptoms can appear as side effects after an extended period of clozapine treatment, which Mr. Emmanuele has had. Dr. Malka stated that the symptoms of excited catatonia have been largely, though not completely, managed with the lorazepam that he is taking.
Dr. Malka advised that Mr. Emmanuele’s auditory hallucinations have continued as described in the previous reporting year (command hallucinations that were derogatory in nature and that occasionally directed him to hurt staff), although for a large part of the current reporting year he has described them as mostly mumbling. He has used as-needed medications to cope with these hallucinations and has also been more able to approach staff for support than he has in the past.
Dr. Malka confirmed that Mr. Emmanuele participated in 15 sessions of cognitive behavioural therapy for psychosis (CBT-p) over the past reporting period before the sessions were discontinued because of apparent deterioration in his mental state. She believed that the sessions were very helpful and was hopeful that they would be resumed.
Dr. Malka reviewed the list of Mr. Emmanuele’s list of psychiatric medications (Hospital Report, p. 44) and pointed out some updates and corrections to that list. She began by pointing out a typographical error in reporting Mr. Emmanuele's lithium dose: she corrected this to state that instead of twice daily, he receives his lithium once per day. The purpose of the lithium is not, contrary to what is reported, to stabilize Mr. Emmanuele's mood. Rather, it is to boost his neutrophil count for his clozapine treatment. In addition, while the medication list reports that lorazepam is for anxiety, for the sake of clarity she would state that it is for catatonia. Similarly, the amantadine is an adjunctive medication also meant for the treatment of his catatonia. Dr. Malka also pointed out that Mr. Emmanuele had been on escitalopram for a very long time so she switched this to duloxetine because escitalopram was not helping with his obsessive-compulsive symptoms. In addition, Dr. Malka pointed out that since the writing of the hospital report, aripiprazole has also been added for the purpose of dealing with the obsessive-compulsive symptoms.
Asked about the reference in the Hospital Report to Mr. Emmanuele having consented to ECT treatment, Dr. Malka advised that he no longer wishes to pursue this as a treatment option. Finally on the subject of medication, it was pointed out that since Mr. Emmanuele's antipsychotic medications are all taken orally, he requires supervision to maintain adherence to his treatment. Dr. Malka stated that he does have insight into his need for it.
At the end of the previous reporting period, Dr. Malka had expressed that a cognitive assessment would be a goal for Mr. Emmanuele for the next year. This has not yet occurred, due to Mr. Emmanuele’s ongoing presentation with active symptoms. However, plans for such an assessment would be made once Mr. Emmanuele is more stable.
With reference to Mr. Emmanuele’s reported lengthy history of substance use, in particular cannabis, Dr. Malka was asked whether he possesses insight into the impact of cannabis on his mental condition. Dr. Malka replied that Mr. Emmanuele has stated that he has no intention of using cannabis again. It is difficult to know what this statement says about his insight because his capacity to communicate his internal experiences and thoughts is still limited. Mr. Emmanuele is essentially in a state of forced remission from cannabis use because of his controlled environment. He is considered vulnerable to relapse with less supervision. He has not been able to engage in any substance use treatment because of the acute nature of his symptoms. Nevertheless, Dr. Malka thought that it is important to maintain, in his Disposition, a provision permitting him to engage in residential substance use treatment at the time when he is able to benefit from this.
Dr. Malka was asked about the risk assessment in the Hospital Report and specifically whether the current risk assessment reflects any change in Mr. Emmanuele’s profile since his admission to the Hospital. She stated that it did not but wished to express her view that the risk of violent offending, expressed as in the moderate range even while he is detained in hospital, is more related to random acts of violence as one feature of excited catatonia. Dr. Malka thought that this condition may explain some of the episodes that have occurred since his arrival at the Hospital. Those incidents appeared to have come out of nowhere and Mr. Emmanuele immediately expressed remorse afterwards. She did not think that these incidents were driven by delusions; rather, they formed part of his excited catatonia presentation.
Dr. Malka addressed Mr. Emmanuele’s use of privileges over the past reporting year, stating that the highest privilege level that he had achieved was Level 3 (unrestricted indirectly supervised access within the hospital building) and more recently he is at level 2 (two-hour indirectly supervised passes within the building) simply because of his limited program attendance. Dr. Malka believed that one way in which Mr. Emmanuele’s obsessive-compulsive symptoms are exhibited is that he feels as though he needs to urinate every 15 minutes and this limits his ability to attend any programs for any significant period of time. The hospital has ruled out medical causes for this situation.
Dr. Malka adopted the factors listed at pp. 53-54 to conclude that Mt. Emmanuele continues to meet the “significant threat” threshold. Dr. Malka believed that a Detention Order is a necessary and appropriate Disposition as Mr. Emmanuele's symptoms are still impacting him significantly and he requires further medication optimization as well as treatment for substance use.
Dr. Malka confirmed that Mr. Emmanuele continues to build his relationship with his mother. He has telephone visits with her (she lives in the Guelph area) and his father (who is in Whitby), who is quite ill. [Mr. Emmanuele interjected at this point to say that he believed that his father had died.] Dr. Malka said that Mr. Emmanuele had just had a telephone visit his father, and the Hospital had received no information that he had passed away. The reason for the recommended increase in the geographical area for Mr. Emmanuele’s community passes is the facilitation of staff-accompanied trips to visit his father.
Dr. Malka confirmed, in response to a question from counsel for the Attorney General, that Mr. Emmanuele’s mother wishes to have contact with him but is not yet comfortable being with him on her own. Accordingly, the treatment team will continue to facilitate visits with staff supervision.
Dr. Malka was asked by Mr. Emmanuele’s counsel to elaborate on the reason for the therapist’s discontinuation of the CBT sessions. She stated that in cases of catatonia, often the treatment strategy is to treat the catatonia to the point where the person is more able to communicate their symptoms. Doctor Malka believed that as Mr. Emmanuele's catatonia improved, he was voicing more of his psychotic symptoms and this was interpreted as a decline in his mental status. Dr. Malka is hopeful that the CBT sessions can resume as soon as possible with a more experienced therapist who is comfortable with patients expressing their psychotic symptoms.
Dr. Malka confirmed in response to questions from the panel that Mr. Emmanuele’s medication is still in the early stages of optimization. She is not considering proposing a community living privilege in his Disposition at this time.
In response to a panel member’s question, Dr. Malka said that she did not necessarily agree with the suggestion that catatonia has become a rarer phenomenon in recent years with the introduction of novel antipsychotic medications. According to the literature, it is an under-recognized condition. In her opinion, the longer a person persists in a catatonic state, the more resistant the condition is to treatment. It was suggested to Dr. Malka that due to the length of time that Mr. Emmanuele has been under treatment but still presents with numerous residual symptoms, a medication consultation service such as the Medical Assessment Program for Schizophrenia (MAPS) could provide some helpful input. Dr. Malka said that she would consider this if the current treatment strategy did not yield the results that she expects.
Dr. Malka believed that, considering that the treatment of Mr. Emmanuele's catatonia has resulted in him being much more able to verbalize his internal experience and his symptoms, she is in a better position to adequately treat the underlying condition and therefore has a clear pathway and strategy forward.
Dr. Malka explained the reason for her thinking that Mr. Emmanuele would not be ready to exercise indirectly supervised community passes within the next 12-month period. She advised that for the treatment of catatonia, she increased the dose of lorazepam medication to the point where Mr. Emmanuele was able to communicate about his experience. At that point, she could begin treating the underlying cause, in this case the obsessive-compulsive component.
The treatment team is currently in the midst of treating this relatively recently recognized component. Once those symptoms are treated, the plan would be to start tapering down the lorazepam. There is a risk of reactivating catatonia as the dose of that medication is decreased. Accordingly, this would be done very slowly and would take some time. Therefore, Dr. Malka thought it was unlikely that in the next year, Mr. Emmanuel would be ready to exercise indirectly supervised community privileges.
No further evidence was led at the hearing following that of Dr. Malka.
Analysis and Conclusions
The panel unanimously accepted the parties’ joint submission and concluded, on the expert evidence of Dr. Malka as supported by the Hospital Report, that Mr. Emmanuele represents a significant threat to the safety of the public. He suffers from a major mental illness, schizophrenia, as well as a cannabis use disorder. Thus far, these conditions have been managed through a combination of medication, abstinence from substances due to Mr. Emmanuele’s situation in the controlled and structured hospital setting, staff intervention and the coping strategies that Mr. Emmanuele has learned.
However, the residual symptoms of his schizophrenia remain very active. with hallucinations being experienced almost daily. During an earlier reporting year, Mr. Emmanuele reported command hallucinations directing him to stab someone, as he did to the victim of the index offence. He clearly requires the ongoing support of the forensic mental health system and the oversight of the Review Board. Without those supports, his mental health would decompensate, and he would likely engage in serious assaultive behaviour that would result in serious, potentially lethal, physical harm and/or serious psychological harm. The re-offence scenario at p. 53 of the Hospital Report is instructive in this regard.
The panel is further satisfied that, as put forward in the parties’ joint submission, the necessary and appropriate Disposition is a Detention Order reflecting the previous Disposition with changes to permit Mr. Emmanuele geographically wider accompanied passes into the community. As explained in the evidence, these passes are to enable him to have visits with his mother and father at their respective residences, with appropriate supervision. The panel noted that Mr. Emmanuele sat mostly quietly through the hearing and did not display any unusual movement or lack thereof.
It is clear on the evidence, however, that neither community living nor indirectly supervised community privileges are realistic within the next 12-month period, during which Mr. Emmanuele’s treatment is being optimized. This must occur, for now, within the hospital setting.
In closing, the panel wishes to commend both Mr. Emmanuele and his treatment team for their positive therapeutic relationship. Mr. Emmanuele has demonstrated a desire to become well and to work with his team as they seek to support him in meeting the challenges that he has already faced. The panel expresses its hope that the positive trajectory that is being established will continue over the year ahead.
The panel has considered the evidence through the lenses of protecting the public as the paramount factor, along with the objective of addressing Mr. Emmanuele’s mental condition, his other needs, and his eventual reintegration into the community.
DATED this 3^rd^ day of June 2026, at the City of Toronto, in the Toronto Region.
Eric Siebenmorgen
Legal Member
____________________________
Office of the Registrar
Ontario Review Board