Re: Israel Msimanga
ORB File No: 7939
Hearing held on: Wednesday, May 13, 2026
Place of hearing: St. Joseph’s Healthcare Hamilton, West 5th Campus Hamilton, Ontario
Pursuant to: Section 672.81(1) of the Criminal Code
Before:
Alternate Chairperson: Mr. S. Clapp Members: Dr. J. Kis Dr. G. Nexhipi Ms. N. Nathanson Mr. S. Doherty
Parties Appearing:
Accused: Israel Msimanga Counsel: Ms. B. Bromberg
The person in charge of hospital: Counsel: Ms. L. Barney
Attorney General of Ontario: Counsel: Ms. C. Gzik
REASONS FOR DISPOSITION
(Dated June 5, 2026)
Introduction:
On September 9, 2021, Israel Msimanga was found not criminally responsible (“NCR”) on account of mental disorder on charges of aggravated assault and failure to comply with probation order (x4), contrary to the Criminal Code. He is currently subject to a Disposition of the Ontario Review Board (“ORB” or the “Board”) dated June 2, 2025 whereby he is discharged from the Forensic Psychiatry Program of St. Joseph’s Healthcare Hamilton, West 5th Campus (“SJHCH” or the “hospital”) with conditions which include: residing at Good Shepherd housing; abstaining from substance use; not possessing any weapons; refraining from contact with the victim of the index offence; attending at the hospital for psychiatric assessment immediately upon request; and not travelling outside of Ontario without first obtaining approval.
On May 13, 2026, a panel of the Board convened at SJHCH to conduct Mr. Msimanga’s annual review pursuant to section 672.81(1) of the Criminal Code. Mr. Msimanga attended the hearing and was represented by Ms. Bromberg.
The following documents were marked as Exhibits: 1) Hospital Report dated April 10, 2026 (including a Good Shepherd HOMES Program Report dated February 10, 2026); 2) Addendum to Hospital Report; 3) Canadian Border Services Agency (CBSA) Document Package; and 4) Deportation Order dated May 4, 2026. In addition to the documentary evidence, Mr. Msimanga’s attending psychiatrist, Dr. Olubukola Kolawole gave oral evidence.
The issues to be decided at the hearing were whether Mr. Msimanga continues to meet the test of posing a significant threat to the safety of the public as set out in section 672.5401 of the Criminal Code, and if so, what is the necessary and appropriate Disposition, taking into account the four factors set out in section 672.54 of the Criminal Code.
Positions of the Parties:
At the outset of the hearing, the parties were asked for their initial without prejudice positions. Ms. Barney, on behalf of the hospital, took the position that Mr. Msimanga remained a significant threat to the safety of the public, and that a continuation of the existing Conditional Discharge was appropriate.
Ms. Gzik, on behalf of the Attorney General, supported the position of the hospital, as did Ms. Bromberg. All parties maintained the joint position during submissions.
Findings:
- For the reasons that follow, the panel found that Mr. Msimanga continues to represent a significant threat to public safety. The panel concluded that the necessary and appropriate Disposition, which is also the least onerous and least restrictive in the circumstances, is a continuation of the existing Conditional Discharge.
Index Offences:
- The circumstances of the index offences are taken from the Crown Brief Synopsis and reproduced at pages 3-4 of the Hospital Report. They were summarized in last year’s Reasons for Disposition (“Reasons”) as follows. On December 17, 2020, Mr. Msimanga assaulted a co-resident at a men’s shelter with a hatchet. The victim’s injuries were described as life changing and required surgery. They included a significant laceration across the bridge of his nose, to the ear, and down; with skin completely severed from his face, as well as a cut to his left hand (believed to be a defensive wound). At the time of the assault, Mr. Msimanga was subject to two probation orders prohibiting him from possessing any weapons and requiring him to keep the peace and be of good behaviour. Mr. Msimanga has stated that he has no recollection of the incident.
Background:
Mr. Msimanga’s personal background is set out in detail in the Hospital Report and was summarized by this writer in last year’s Reasons as follows. Mr. Msimanga is now 40 years old. He was born in South Africa and came to Canada in 2008. He reported that his mother was of Ndebele descent and his father was of Zulu descent, and he was exposed to violence and turmoil in South Africa as a result of poverty and xenophobia. His parents had very busy work schedules, so he was raised by his maternal grandparents. He has one brother who was raised by other family members. Mr. Msimanga’s father died in the early 2000s. When he came to Canada he lived with his mother and brother in Toronto, until his mother’s death in 2011. After his mother died, Mr. Msimanga moved to Hamilton and lived with a girlfriend for approximately six years, until the relationship ended.
Mr. Msimanga completed high school in South Africa and had started a computer engineering program before he moved to Canada. He obtained a Personal Support Worker (“PSW”) certificate in 2014. He worked as a PSW until 2017 and then worked in construction. He was laid off in 2019, and subsequently became homeless and lived in shelters. He started associating with the “wrong crowd” and used drugs.
Mr. Msimanga has a history of cannabis and alcohol use since he was approximately 18 years old, and used crystal methamphetamine on a regular basis commencing in 2019.
Mr. Msimanga is the father of two young children. His first child was born in November 2024 and his second was born in February 2026. Both children are in the care of his partner’s mother with involvement from Hamilton Child and Family Services (HCFS). Mr. Msimanga is very involved in his children’s care.
Mr. Msimanga obtained full-time employment in May 2023.
Criminal History:
- Prior to the index offences, Mr. Msimanga had a criminal record that commenced in 2019 and included convictions for assault with a weapon and failing to comply with court orders.
Psychiatric History:
Mr. Msimanga’s psychiatric history was summarized by this writer in last year’s Reasons as follows. According to the Hospital Report, Mr. Msimanga was brought to hospital in Toronto by police in July 2009 after a verbal altercation with his mother and expressing suicidal ideation. He was released from hospital the same day to stay with his girlfriend. According to records from the SJHCH Crisis Outreach and Support Team, Mr. Msimanga contacted police in December 2018 and again in January 2019 and reported that “people were hiding in his walls and trying to hurt him and his dog” and “people were breaking into his apartment.” On each occasion, Mr. Msimanga endorsed recent crystal methamphetamine use and did not meet criteria for involuntary admission. He was provided with information regarding mental health resources, as well as supports for his substance use.
Mr. Msimanga endorsed experiencing persistent auditory hallucinations since 2018, even when he was not using substances. The voices suggested he could be harmed, made deprecating comments about him, and sometimes encouraged him to kill himself.
Following his arrest for the index offences, Mr. Msimanga was admitted to SJHCH from the Hamilton Wentworth Detention Centre on a Form 1 under the Mental Health Act. He was described as uncooperative, selectively mute, responding to internal stimuli, highly suspicious, disorganized in his thinking, and with poor personal hygiene. This admission lasted four months. He was found incapable of consenting to treatment and the Public Guardian and Trustee was his substitute decision-maker. He improved with treatment, although he still endorsed some auditory hallucinations, and was discharged back to the Detention Centre.
Since being under the jurisdiction of the Board, Mr. Msimanga has been adherent to medication and his insight has improved, but remains limited. He generally engages constructively with the treatment team and has a positive attitude towards authority. He has continued to endorse mild residual symptoms in the form of hearing voices. He has struggled to manage his substance use, and tested positive for cannabis in September and November 2022. After his first 24-hour indirectly supervised pass into the community in April 2023, he tested positive for cocaine. Mr. Msimanga has attended the concurrent disorder group and the substance use group while in the hospital.
Mr. Msimanga was discharged to Emmaus Place on November 4, 2024, and was reporting to the treatment team approximately six to eight times per month. He was granted a Conditional Discharge following last year’s hearing. It was the opinion of the treatment team that a consent to treatment condition was not required because Mr. Msimanga was consistently compliant with medication and was “scared” to stop it. It was also the opinion of the treatment team that Mr. Msimanga would likely agree to a voluntary admission if recommended.
The Hospital Report stated that Mr. Msimanga’s diagnoses are: Schizophrenia; Stimulant and Cannabis Use Disorder, in remission in a controlled environment; and Alcohol Use Disorder, in remission in a controlled environment. He is capable of consenting to psychiatric treatment and managing his property.
Evidence at the Hearing:
The Addendum to the Hospital Report outlined a recent development in Mr. Msimanga’s life. Ms. Msimanga arrived in Canada in 2008 and is a Permanent Resident. The Immigration Division of the CBSA scheduled an Admissibility Hearing for Mr. Msimanga in relation to a conviction for assault with a weapon in 2019 (this occurred prior to the index offences). He was referred to the Hamilton Refugee Law Office through Legal Aid Ontario and was able to obtain a lawyer. The Admissibility Hearing occurred on May 4, 2026 and a Deportation Order was issued. Ms. Bromberg advised that Mr. Msimanga intends to appeal the Deportation Order.
The Addendum to the Hospital Report stated that as of April 15, 2026, both of Mr. Msimanga’s children were placed in temporary Kinship Care through HCFS, with Mr. Msimanga’s partner’s mother as the children’s temporary Kinship Caregiver. Mr. Msimanga is no longer considered the children's legal guardian. His partner’s mother allows him to see his children on a frequent basis and will ask him for physical or financial help when needed. Mr. Msimanga does not require supervised visitation; however, his partner, who currently lives in a shelter, does.
The Hospital Report stated that Mr. Msimanga’s mental status remained stable throughout the reporting period. He was adherent to his medication regimen and consistently attended outpatient appointments on time and presented with appropriate hygiene and attire. His overall presentation was calm and polite; however, he frequently appeared superficially pleasant with a notable focus on impression management. He was not overly forthcoming with the clinical team, and the outpatient team had to review with him the importance of transparent communication. He met with the Forensic Outpatient Team between 6 and 12 times per month throughout the reporting period. The frequency of his clinical reporting varied in response to the stressors he was experiencing, allowing for close monitoring of his mental status.
Mr. Msimanga continued to work full-time hours with opportunities for overtime as a Facility Operator at a waste management company (he took paternity leave after his second child was born earlier this year). When he is not working, he spends most of his spare time caring for his children or attending the gym. Mr. Msimanga was referred to a Healthy Babies, Healthy Children Program in February 2026. Through this program he will be assigned a Public Health Nurse once per month and a Family Visitor twice per month. He has also been referred to several local emergency services for food and baby essentials.
The Hospital Report stated the following about Mr. Msimanga’s insight (at page 58):
“A central concern during this reporting period has been Mr. Msimanga’s limited insight into his mental illness and treatment needs. He continues to question his diagnosis of schizophrenia, attributing his index offence to substance use rather than an underlying psychiatric disorder. He has expressed uncertainty regarding the necessity of ongoing antipsychotic treatment and has indicated that he may not require medication or follow-up care in the future, particularly if granted an Absolute Discharge. This remains a significant dynamic risk factor, as it raises concern for potential treatment disengagement in the absence of forensic oversight.”
The Hospital Report also stated that Mr. Msimanga’s insight into the impact of substance use on his mental health and the need for ongoing relapse prevention support remains limited. While he acknowledged that alcohol use was bad for him, he did not identify cannabis use as detrimental to his mental health. He declined a referral to the Good Shepherd Team 5 program for relapse-prevention support, reporting that he has no intention of returning to substance use in the future. Mr. Msimanga consistently denied substance use, and all urine drug screens collected during both scheduled and random visits were negative for illicit substances.
Mr. Msimanga is capable of managing his finances and property; however, he demonstrated several challenges with financial management throughout the reporting year. While he has income from his full-time employment (approximately $2,000 per month), this is not enough to cover his rent, phone bill, pharmacy bill, groceries, and other necessities. Mr. Msimanga has frequently entered rental arrears as well as arrears at the pharmacy. He also regularly lends money to his partner’s mother and is often responsible for purchasing baby and child-related necessities for his children. He has had to borrow money from his brother on multiple occasions to help pay for various expenses. The treatment team continue to look for ways to support Mr. Msimanga and his family.
The Hospital Report stated that Mr. Msimanga remains a significant threat to the safety of the public. The Forensic Risk Formulation stated the following (at page 60):
“Mr. Msimanga’s historical risk is anchored by a serious mental disorder, prior substance use, limited insight, and a history of violent offending. Over the current reporting period, he has demonstrated clinical stability, treatment adherence, and functional engagement in the community, including employment and parenting responsibilities.
However, this stability is highly contingent on ongoing forensic and clinical supports. Persistent concerns regarding limited insight, impression management, stress vulnerability, and financial instability suggest that his ability to maintain stability independently remains uncertain. The most plausible future risk scenario involves gradual disengagement from treatment, discontinuation of medication, and accumulation of unmanaged stressors, which could lead to psychiatric decompensation and increased risk of violence.
Under the current conditions of a Conditional Discharge, including structured supports, regular monitoring, and treatment adherence, his risk is appropriately managed. However, in the absence of these supports, his risk would likely increase to a moderate-high level over time.”
Dr. Kolawole testified that he has been Mr. Msimanga’s attending psychiatrist for approximately two years. He reiterated Mr. Msimanga’s areas of progress in the context of the Conditional Discharge, including engagement with the treatment team, adherence to medication, stable housing, full-time job, abstinence from substances, an active involvement with his two children. Dr. Kolawole also highlighted some areas of concern, including limited insight, financial difficulties, and psychosocial stressors (including the recent CBSA proceedings and Deportation Order).
Dr. Kolawole testified that Mr. Msimanga is internally motivated and receives external support from the Forensic Outpatient Team, his case manager, and Emmaus Place staff. Mr. Msimanga’s partner’s mother and his brother are also very supportive of him.
Dr. Kolawole was asked about Mr. Msimanga’s reluctance to disclose information and/or stressors to the treatment team. He responded that Mr. Msimanga was concerned that if he disclosed certain things they would be characterized as stressors and would have a negative impact on his progress in the forensic system. Dr. Kolawole stated that Mr. Msimanga has shown some improvement in this regard over the last few months, especially in light of the recent CBSA proceedings.
Analysis and Conclusion:
The panel found that the evidence contained in the Hospital Report, and presented by Dr. Kolawole, supported a finding that Mr. Msimanga continues to represent a significant threat to the safety of the public. While Mr. Msimanga had a very good year overall while living in the community, it was clear on the evidence that this stability was contingent on the ongoing forensic and clinical supports provided by the hospital, treatment team, and housing staff. In the absence of the current forensic oversight, Mr. Msimanga is at risk of nonadherence with his medication, relapse into substance use, and a decompensation of his mental health. The resultant relapse into psychosis would predispose him to violence toward members of the public, as happened at the time of the index offences, and also in 2019 when he was convicted of similar offences.
The panel accepted the joint submission that the necessary and appropriate Disposition is a continuation of the Conditional Discharge. Mr. Msimanga continues to require the structure, supervision, and support given the concerns around insight, financial instability, and ongoing psychosocial stressors.
DATED this 5th day of June 2026, at the City of Toronto, in the Toronto Region.
Ms. S. Clapp Alternate Chair
Office of the Registrar Ontario Review Board