Ontario Review Board
Re: Hamza Dhaqane Ahmed
ORB File No: 8141
Hearing held on: Tuesday, April 21, 2026
Place of Hearing: Royal Ottawa Mental Health Centre
Pursuant to: Section 672.81(1) of the Criminal Code
Before:
Alternate Chairperson: Mr. P. Hageraats
Members: Dr. W. Johnston Dr. R. Cormier Mr. D. D’Intino Mr. M. Hajek
Parties Appearing:
Accused: Hamza Dhaqane Ahmed Counsel: Ms. M. Munsterman
Person in charge of hospital: Representative: Dr. J. Hwang
Attorney-General of Ontario: Counsel: Ms. M. Dufort
REASONS FOR DISPOSITION
(Dated May 26, 2026)
Introduction
Ms. Hamza Dhaqane Ahmed was tried in court in 2022 on charges of assault (x4), assault with a weapon (x2) and assault to a Peace officer, offences contrary to the Criminal Code of Canada.
On September 7, 2022, expert psychiatric evidence was presented at the trial. As a result, Ms. Ahmed was found not criminally responsible on account of mental disorder (“NCR”).
Ms. Ahmed is subject to a disposition of the Ontario Review Board (“ORB” or “the Board”), dated April 14, 2025, detaining her at the Forensic Unit of the Royal Ottawa Mental Health Centre (“ROMHC” or “the hospital”).
In the disposition, privileges were granted. These included travel passes to enter the community of Ottawa/Gatineau within 200km of the hospital for up to seven days. In addition, the hospital was authorized to approve Ms. Ahmed’s placement in the community in accommodation designed to meet her needs.
Two previous ORB dispositions - dated December 22, 2022, and January 12, 2024 – had discharged Ms. Ahmed subject to conditions. She has not lived in the community for more than a year but currently remains on inpatient status at the hospital’s Forensic Rehabilitation Unit.
On April 21, 2026, the Board convened at the ROMHC to conduct an annual review. Ms. Ahmed attended in person. She was represented by counsel, Ms. Marnie Munsterman.
Throughout the hearing, Ms. Ahmed was provided with ongoing interpretation from English by the official Somali Arabic Interpreter who sat beside her.
At the hearing, the Board received direct testimony from the attending forensic psychiatrist, Dr. Jiyoung Huang. The evidence also included a cumulative hospital report, dated March 31, 2026.
The issues to be considered by the Board are whether Ms. Ahmed presents a significant threat to the safety of the public, and, if so, to determine the necessary and appropriate disposition.
Positions of the Parties
At the outset, the parties agreed that Ms. Ahmed does present a significant threat. It was further agreed that, to manage the level of threat, a renewed detention order is appropriate.
The Board was called upon to resolve only one issue in dispute. It was Ms. Ahmed’s position that she should be granted more ample travel privileges, specifically, international travel for a pilgrimage to Mecca.
For the reasons set out below, while adopting all aspects of the joint submission, the Board declined to award international travel privileges. The current detention order was renewed, without change.
Current Psychiatric Diagnoses, Hospital Report, p. 48
Schizoaffective Disorder, Bipolar Type - in sustained remission since October 2025
Prominent borderline personality traits contributing to situational behavioural dysregulation.
- The following passage appears in the hospital report, p. 47:
“Despite this remission, Ms. Ahmed continues to demonstrate residual affective vulnerability and behavioral reactivity, particularly in response to sleep disruption and psychosocial stressors such as family separation or perceived loss of autonomy. Periods of decompensation typically emerge after several days of poor sleep and are characterized by irritability, loudness, impulsivity, and, at times, escalation to throwing objects, verbal threats, or attempts to leave the unit against medical advice. These episodes are generally brief, resolve without significant medication changes, and respond more consistently to behavioral interventions, including firm limit-setting and supportive structure, than to pharmacologic escalation.”
- At last report, Ms. Ahmed was being treated with oral psychiatric medications. These included:
Aripiprazole 15mg daily (antipsychotic)
Olanzapine 15mg nightly (antipsychotic)
Quetiapine 800mg nightly (antipsychotic)
Epival 1000mg nightly (mood stabilizer)
Lamotrigine 25mg twice per day (mood stabilizer)
Index Offences
- The offences arose on a series of dates, beginning in early 2020. In summary:
On March 27, 2020, Ms. Ahmed was living in a supported group home, Parklane Residence. While holding a butter knife, she assaulted a staff member. The victim feared for her safety and fled to another room. Ms. Ahmed was taken to the Montfort Hospital where she was treated with long-acting injectable medication and later discharged on April 9, 2020. While Ms. Ahmed was later determined to be criminally responsible for this offence, the Board has been permitted to include the circumstances in its consideration.
On July 16, 2020, Ms. Ahmed was involved in three incidents at different locations. That morning, while at the Ottawa Hospital General Campus, she became irate, violent, and aggressive to hospital staff members. She spit in the face of a patient care assistant. She threw a glass of milk and water at a nurse. After telling her she would be discharged, security escorted her outside. Ms. Ahmed pulled a plastic hand sanitizer dispenser off the wall. Soon after, she was arrested by the police who released her on an undertaking. At her request, by noon hour, they dropped off at a location near Walkley Road and Albion Road.
Later that same day, Ms. Ahmed was involved in an altercation with strangers on the street. She began yelling and ran toward a person who was waiting at a bus stop. She tried to spit on this person, who managed to run away.
Continuing along the road, she watched traffic entering and exiting a Tim Horton’s coffee shop area. She began to yell and slammed a shopping cart into a vehicle that was leaving. The driver got out of the vehicle and removed the shopping cart before calling the police.
The responding police officer received another call about a disturbance further down Walkley Road, where Ms. Ahmed was arrested. Taking her to the Civic Hospital, the police released her on an undertaking.
Later that same day, Ms. Ahmed was driven to the Shepherds of Good Hope, a homeless shelter in downtown Ottawa. On arrival, she walked directly toward a staff member who did not know her. Ms. Ahmed was carrying a large black shoulder bag. Approaching the victim quickly, she struck the staff member on the left shoulder with the bag. The staff member tried to run away; however, Ms. Ahmed followed her into the building, intending to strike again.
On September 24, 2021, Ms. Ahmed was an inpatient on the psychiatric unit of the Ottawa Hospital – Civic Campus. A hospital employee asked her to leave the “employee only” seating area. Ms. Ahmed became upset and told the victim to shut up. She threw a cup of hot coffee at the employee, striking her on the lower right of her back. She then threw a tray, flipped a sign, and threw more coffee into the hallway where others were walking by. Security removed her from the premises. Responding police officers arrested her on an undertaking after bringing her to the Queensway-Carleton Hospital.
A day later, on September 25, 2021, Ms. Ahmed was again an inpatient on the psychiatric unit of the Ottawa Hospital Civic Campus. Security was called when she began to bang and spit on a glass window. Three security guards were needed to bring her back to her room. Once there, she spat directly onto the victim’s face mask, vest and pants.
By then, Ms. Ahmed was bound by two Court undertakings, with conditions not to attend the Civic Hospital in Ottawa.
On February 4, 2022, she showed up at the Civic in the late evening, complaining of an upset stomach. While In the waiting room, she caused a disturbance by yelling and hitting the plastic seating partitions. She started a verbal argument with another patient. Security escorted her off the property. On the way out, Ms. Ahmed slipped on the ice. A special constable with OC Transpo spoke to her. She asked to return to the hospital. Paramedics responded and brought her inside.
Soon after midnight on February 5, 2022, the nurse assessed her in the triage area. Ms. Ahmed told the nurse to shut up. She assaulted the nurse, punching her in the face with her left hand while holding a vomit bag. Security members arrested her. Police were called who took her to a cell block to be held for a bail hearing.
On February 14 and 17, 2022, while awaiting trial and being held in detention at the Ottawa- Carleton Detention Centre, Ms. Ahmed was admitted to the Ottawa General Hospital on a temporary pass. Two female OCDC corrections officers were assigned to guard her.
On February 14, 2022, a corrections officer escorted Ms. Ahmed to the washroom so she could do her morning prayers. Her handcuff was removed from the bar of the bed; she was then handcuffed to the front and went to the washroom, completing her prayers. Returning to her bed she pulled her hand away from the officer who was about to transfer one handcuff to the hospital bar bed. Ms. Ahmed dug her right fingernail into the officer’s left wrist. The officer received numerous scratches, some of which bled, requiring cleaning and bandaging by a hospital nurse.
On February 17, 2022, and while still in custody at the Ottawa General Hospital, a corrections officer was helping Ms. Ahmed with her meal. Ms. Ahmed pulled away as the officer went to secure her hand: she told the officer, “I will kill you” numerous times. She then spat at the officer twice, hitting the leg of her uniform. The officer tried to gain control of Ms. Ahmed’s arm but was struck in the chest. Ms. Ahmed dug her nails into the officer’s wrist, causing scratching and breaking of the skin. Once Ms. Ahmed was put under control, nursing staff cleaned the officer’s wounds and bandaged her injuries.
On September 7, 2022, and following the NCR finding, the Court released Ms. Ahmed on a Bail Recognizance, requiring her attendance at the ROMHC. With intensive support provided by the ACT Team until her initial ORB hearing in early December 2022, Ms. Ahmed, was able to manage without any further reported incidents while living in an independent apartment that had been arranged.
Personal Background
Ms. Ahmed is 55. She remains single and has no children. She was born in Mogadishu, Somalia, the youngest in a family of 14 children. When she was 13, her father died suddenly of kidney failure. The family otherwise remained intact.
The family was affected by civil war in Somalia. Until then, Ms. Ahmed had done well, both socially and in school where she had good grades. She graduated from high school and was about to start university when the family home was destroyed by a bomb. Fortunately, no one was home at the time. A sister recalls that Ms. Ahmed's behaviour began to change. Family members believe that trauma may have contributed to her mental health problems.
In 1991, at age 21, Ms. Ahmed fled the country amid widespread wartime sexual violence. She moved to Ethiopia, then to Germany, and from there, to the Netherlands. In 1995, she married a Canadian citizen who sponsored her for permanent residency in Canada. Once in Ottawa, Ms. Ahmed did not live with the husband. Instead, she moved in with some of her siblings who were already established here.
In 1996, Ms. Ahmed had her first hospitalization relating to mental illness. Family members called police reporting she was occasionally acting out violently and refusing to leave the home. She briefly lived in Montreal, with a different sister, before returning to Ottawa. Ms. Ahmed then travelled to Ethiopia for about a year, during which time she divorced her husband.
In 2010, she moved to Toronto, where she was in a homeless shelter for a year. Apart from these periods, and a brief stay in Vancouver, Ms. Ahmed has lived mostly in Ottawa.
In 2014, Ms. Ahmed traveled to Somalia, where she married into a polygamous relationship. The marriage ended in divorce when the husband failed to obtain a passport to travel to Canada.
Ms. Ahmed’s relations with her direct family are somewhat strained. Sisters and a brother living in Ottawa are her main sources of support. She has several other siblings elsewhere in Canada.
Ms. Ahmed has never been employed. She is supported by the Ontario Disability Support Program.
Psychiatric History
Ms. Ahmed has a history of paranoid delusions, aggressivity and disorganized thinking. She has struggled with non-compliance with recommended antipsychotic medications including the long-acting injectable format. For the past years, only oral medications have been prescribed.
Ms. Ahmed has experienced longstanding social anxiety. When non-compliant with treatment, she experiences rapid decompensations of mental illness. She can also decompensate even when she adheres to treatment. Interpersonal hypersensitivity and mood lability, even when not experiencing acute mood or psychotic episodes, have been observed over time.
Since September 2022, when she first came under the jurisdiction of the Ontario Review Board, Ms. Ahmed has shown some insight into her major mental illness and the need for medications. However, owing to the rapid cycling nature of symptoms, she has experienced restrictions of her liberty and various setbacks. Several adjustments to medications have been needed through her course of treatment.
In January 2023, when Ms. Ahmed was living independently in her own apartment, her condition decompensated. She was admitted to the Ottawa Hospital – Civic Campus on January 23, 2023, and remained there until February 2024. As she regained stability, consideration was given to placement in either a group home or a long-term care setting. In the months following, the treatment team consulted her family about possible options.
In August 2024, Ms. Ahmed showed more irritability and isolation.
After a medication adjustment, depressive symptoms appeared to resolve, only to re-emerge several weeks later. The treatment team took this as evidence for a rapid cycling mood disorder. With another medication adjustment, she became more engaged and active on the unit and began to attend physical therapy while making appropriate use of her passes.
Ms. Ahmed has been agreeable to stay on the Royal’s Rehabilitation Unit as a voluntary patient. The hospital has made repeated efforts at planning her discharge. Unfortunately, complications keep happening. This partly has to do with Ms. Ahmed’s expectation that her family will agree to whatever is being proposed. However, on the various occasions when discharge planning was attempted, the family would continually decline available housing options that were being put forward.
When acting as Power of Attorney and Substitute Decision-Maker for personal care, they would object to both long-term care residences and group homes. Complicating matters further, the family’s cultural preference has been to not make decisions unless with the unanimous agreement of all involved. Even regarding decisions about recommended antipsychotic medications, the family has not been able to come to full agreement.
In this context, Ms. Ahmed’s requests for overnight family visit passes have been held back. Notably, throughout her current extended stay in hospital, Ms. Ahmed has not been able to access a single overnight stay with family members. Previous overnight passes resulted in medication non-adherence and deterioration of mental stability. As noted, Ms. Ahmed’s decompensations have been extremely rapid.
Ms. Ahmed’s general medical condition presents added concerns. Based on testing done by occupational services, she is dealing with several functional challenges. Testing completed in January 2025 shows that she needs assistance with medication supervision, bathing, compression stocking changes, meal preparation, prompting for cleaning and laundry, assistance navigating stairways and now, with toileting. At last year’s ORB hearing, held on April 2, 2025, long-term care was considered the most suitable community-based option.
Last year, family members, including the brother who held power of attorney for personal care, opposed having Ms. Ahmed go to long-term care. He believed she should remain in hospital for the rest of her life. This raised ethical concerns for the hospital.
At last year’s hearing, Dr. Linthorst testified about Ms. Ahmed’s strengths. She was willing to work with the treatment team both in and out of her cycling mood symptoms. Her symptoms had improved before April 2, 2025, and, for several months, she had not displayed clear depressive symptoms. Dr. Linthorst described Ms. Ahmed as having limited understanding of her psychotic illness. He stated she did not believe she suffered from psychotic symptoms. Dr. Linthorst also testified that Ms. Ahmed did not understand that she has a potential mood disorder requiring medication.
At the April 2025 ORB hearing, Ms. Ahmed’s desire to travel to Mecca was discussed. Dr. Linthorst advised that a prolonged period of stability, six months to a year, would be preferable before extended travel could be approved. Dr. Linthorst highlighted the concerns of occupational functioning as well as concerns regarding the family’s willingness to support Ms. Ahmed’s compliance with prescribed antipsychotic medications.
Before even considering limited travel to Quebec, he added, this would only be approved if the hospital could first be satisfied there were no concerns about medication compliance. Ms. Ahmed’s family had their own opinion about her treatment. It was Dr. Linthorst’s clear impression that the family’s view on this did not align with the hospital’s recommendations.
The Board considered Ms. Ahmed’s request last spring, when she sought permission to travel to Mecca. Her counsel suggested such a privilege would offer Ms. Ahmed an incentive to work with the hospital. Opposing counsel pointed out it was unlikely Ms. Ahmed would progress sufficiently to qualify for such extended travel. In declining the request, the Board referred to evidence of Ms. Ahmed’s rapid decompensations within days of her having stopped medication in the past, which led to her having to remain in hospital for over 500 days to address resurging symptoms.
The Board noted that Ms. Ahmed was not on any form of long-acting injectable medication, coupled with the fact that the family was not unanimously supportive of such treatment. Noting further Ms. Ahmed’s requirement for several functional supports, the Board concluded it was not possible to ensure public safety by granting her international travel privileges.
Course in Treatment, April 2025 to April 2026
Ms. Ahmed continues to reside on the Forensic Rehabilitation Unit. She has displayed episodic behavioral dysregulation, associated primarily with sleep disturbance, physical pain, and difficulty tolerating limits, rather than recurrent psychotic or syndromic mood episodes.
In April and May 2025, Ms. Ahmed showed intermittent hypomanic symptoms: pressured speech, irritability, poor sleep, grandiosity and poor insight into her illness. She was also described as demonstrating poor insight into the role of the ORB and the reasons for her ongoing detention. She was expressing confusion and distress about being hospitalized and was fixed on her immediate wish to travel to Mecca. Despite repeated education about her legal status and ORB conditions, with translation support, she was able to demonstrate partial understanding. Ms. Ahmed continued to decline long-acting injectable antipsychotic medication.
The current treating psychiatrist, Dr. Hwang, wants to simplify the regime of prescribed medications. To this end, she has been adjusting the oral medications: Lamotrigine (titrated down, it is now eliminated); Quetiapine (progressively increased); and Aripiprazole (reduced, due to extrapyramidal symptoms).
Ms. Ahmed’s psychiatric status began to stabilize significantly in June 2025. By October 2025, she reached full remission. In November and December of 2025, Ms. Ahmed remained psychiatrically well. However, she experienced stress-related behavioral dysregulation, episodic falls and worsening pain. Details of her sleep disruption and irritability are set out in the hospital report, p. 45.
In January 2026, there was a relapse of mood and sleep variability. Ms. Ahmed was making inappropriate and aggressive comments and gestures to staff members and other patients. In February, Ms. Ahmed was showing limited behavioural decompensation, triggered by interpersonal conflict, religious distress, phone restriction and sleep deprivation.
Over one weekend, she displayed verbal aggression, medication refusal, threats with physical aggression, and was throwing objects at patients and staff. This culminated in a code white. Angry expressions of suicidal ideation were documented, which she later retracted. Intensive intervention with consistent use of tightened phone restrictions, scheduled PRN medications, consistent translation support and firm boundaries led to gradual stabilization. By the end of February 2026, Ms. Ahmed’s irritability had reduced. She was getting better sleep and showing improved acceptance of behavioral limits.
In March 2026, she continued to consolidate gains in terms of stable mood, improved insight, consistent sleep and appropriate use of privileges and was benefiting from extended daytime passes to be with family.
Throughout the current reporting year, Ms. Ahmed has lived with significant functional dependence. She needs prompting for hygiene, medication administration, meal spacing and mobility-related tasks including assistance at putting on compression stockings. She often reports functional incapacity. She experiences pain, fear of falling and reliance on support in terms of her mobility and general physical abilities. Her medical course is described as notable for chronic back, knee and leg pain (arthritis), intermittent incontinence, episodic falls and dental issues. Pain and sleep disturbance have had a clear impact on her emotional regulation. The hospital has been managing her medical issues collaboratively with family medicine. This contributes to their ability to deal with Ms. Ahmed’s behavioral fluctuations.
Ms. Ahmed demonstrates some capacity for treatment and finances. However, she lacks capacity for disposition decisions in that she does not appreciate the risks of independent living or of unsupervised medication management. Both she and her family continue to repeatedly express resistance to long-term care, largely due to age, cultural concerns, and preference for a private room. Multidisciplinary assessments have concluded she requires 24-hour supervised care due to ongoing needs for medication oversight, prompting for ADL’s, physical support and behavioural structure.
The hospital conducted an extensive family meeting last year with more than ten family members participating. Following their agreement, a long-term care application was initiated. However, it was declined in early 2026, given the level of agitation she had demonstrated in February on the hospital unit.
Current Violence Risk Assessment
Dr. Hwang made recent use of the HCR-20-v3, Structured Clinical Judgment Instrument. Upon reviewing the three main violence risk categories, including historical, clinical and future items, Dr. Hwang is of the opinion that Ms. Ahmed presents a moderate risk of future violence and that she continues to represent a significant threat to the safety of the public.
The current treatment plan will focus on behavioural therapy. This is in addition to ongoing targeted adjustments to the medication regimen. The hospital hopes to develop and implement an individualized behavioural management plan addressing affective instability, boundary setting and adjusting to staff-splitting behaviours. The purpose is to reduce the frequency and intensity of verbal outbursts and to support consistent adherence to unit expectations. They anticipate that Ms. Ahmed’s behavioural regulation will further improve, thereby supporting a renewed application for placement into long-term care.
Evidence at the Hearing
The Board also received direct testimony from the attending forensic psychiatrist, Dr. Jiyoung Hwang. Dr. Hwang is the author of the updated hospital report. She provided further explanations before responding to questions posed by the parties and members of the Board.
Ms. Ahmed’s behaviour has shown continued improvement regarding her impulsivity and interactions with staff. Recently, on April 4, 2026, a key family member, Ms. Ahmed’s niece was married. As the wedding date approached, Ms. Ahmed appeared to take on greater motivation to deal with her emotional regulation. For the first time in her now lengthy hospitalization, the treatment team had confidence in granting her an overnight pass to attend the wedding and stay with family members. Ms. Ahmed was told this was conditional on her remaining polite to staff.
Ms. Ahmed attended the April 4 wedding as planned. However, instead of spending the night with family, she returned that same evening, without accessing the overnight pass. Contrary to the treatment team’s understanding, family members had instead brought her back the same night at 1:30 a.m. It appeared that Ms. Ahmed had not taken any of her evening medications as she had been expected to do when with family.
When the family later reported there had been no behavioural issues at the wedding, they showed no awareness as to whether Ms. Ahmed had in fact taken her evening medications. The hospital was concerned, knowing from experience that missed medications for Ms. Ahmed can see her progress to developing mood episodes rather quickly
Dr. Hwang described a new problem regarding incontinence. This may relate to the fact that Ms. Ahmed has been storing food in her room for long periods of time, only to have it spoil.
Dr. Hwang attributes Ms. Ahmed’s improved behaviors to her desire to attend the April wedding. Dr. Hwang has come to view the patient’s behavioural disturbances as more clearly related to personality structure than to mood episodes or psychotic episodes. This aspect now leads the treatment team and Dr. Hwang to shift the treatment plan toward behavioral therapy.
Ms. Ahmed is being encouraged to follow hospital rules and be respectful of staff. She is being helped to gain deeper understanding of how staff are there to support and help her. Dr. Hwang has been adjusting the patient’s medication levels and eliminating others from the prescribed regimen.
Regarding the request for international travel, Dr. Hwang advised that given the failure to complete the overnight pass on April 4, and the family’s inability to monitor medications, Dr. Hwang does not support international travel. It is much too premature to test the patient’s ability to undertake any trip to Mecca. It makes more sense to first try overnight passes within the Ottawa area.
Dr. Hwang noted, their attempt to implement the April overnight pass was the only overnight pass in the current reporting year that has ever been granted. Moreover, even on those other occasions when Ms. Ahmed is granted day passes to visit family members, the family has difficulty following hospital rules. The hospital needs to see Ms. Ahmed return by 9:00 p.m., when the outside doors are closed for the night. Instead, the family has been bringing her back well past the 9:00 p.m. deadline. This puts hospital staff in the difficult position of having to come downstairs under special arrangement to have Ms. Ahmed come inside.
Responding to questions posed by Ms. Dufort, counsel for the Attorney-General, Dr. Hwang advised as follows:
(a) In the weeks leading up to the April 4 wedding, Ms. Ahmed worked hard to deal with her conduct and gain better control over her behaviors. Ms. Ahmed has some ability to work toward greater access to the community involving more extended stays outside the hospital.
(b) It would be a much more substantial goal for her to start working on the ability to travel to Mecca. The family’s ability to help Ms. Ahmed manage her various and extensive needs is a limiting factor.
(c) The existing local travel privilege, for up to 7 days in the Ottawa and Gatineau areas, can remain in place.
(d) Ms. Ahmed’s future ability to leave the hospital for more than one night will depend on her continuing to do well. The team first needs to see how she will do with weekend passes.
(e) At this point, the hospital requires a family member to come forward who is willing to become an approved person to accompany Ms. Ahmed on passes. This would likely be one of her sisters or a brother.
- Dr. Hwang responded to questions posed by Ms. Munsterman, counsel for the patient:
(a) Ms. Ahmed is capable to consent to her own psychiatric treatment. However, her capacity to make decisions about discharge planning is problematic. Ms. Ahmed will ask the team to discharge her from hospital to an independent apartment while having no real understanding of her physical limitations. She does not really grasp her need for staff assistance, 24-7, including with meal preparation.
(b) Ms. Ahmed requires added support for her special medical and mental health issues.
(c) Placement within a community group home will not work. The hospital is considering a renewed application to long-term care. This is even though - at the relatively young age of 55 - most LTC agencies would not consider her eligible.
(d) Ms. Ahmed’s mental health needs present a major barrier to LTC admission. The pool of possible community placements is very limited. Mental health agencies that deal with behavioural issues are not equipped to deal with her separate medical and mobility issues.
(e) Now that the treatment team is focusing on behavioural therapy, they hope to see further improvements, including a reduction in aggressive outbursts.
(f) Ms. Ahmed’s siblings still come see her at the hospital and bring her on visits into their homes.
(g) The family’s understanding of Ms. Ahmed’s mental illness is not that good. One main source of community support is the niece whose wedding was recently celebrated. The niece also helps the hospital by providing the treatment team with valuable collateral information.
(h) A case conference was recently set up to provide the family with intensive education. However, no family members attended. The hospital then reached out again by email. Only one person responded, her niece, who already understands Ms. Ahmed’s needs quite well.
(i) The treatment team needs the family to do better when they return Ms. Ahmed to hospital following passes into the community. It is up to family to bring her up to the nursing station before the outside doors close at 9:00 p.m. On too many occasions, she has been left outside at the locked street entrance, past curfew deadline.
(j) Upon her return to the nursing station, the team needs to hear family members’ report on how Ms. Ahmed managed while away. Otherwise, the hospital cannot contemplate more extended community access, beyond daytime passes as opposed to overnight.
(k) On returning from the April 4 wedding at 1:30 a.m., and contrary to what had been arranged earlier, the family did not report why she did not stay with them overnight.
(l) The family has not been working with the treatment team on Ms. Ahmed’s need for medication management.
(m) Regarding the request for travel to Mecca, so far, no family members have been involved in any discussions with the treatment team. At one point earlier, they did report that Ms. Ahmed was upset about not being able to go to Mecca.
(n) Dr. Hwang was asked whether granting her the chance to travel internationally travel would serve as a motivator for Ms. Ahmed, to possibly help her work on her behaviours and other issues. Dr. Hwang was concerned that if this were included in the disposition, Ms. Ahmed would only fix on the “big goal”. Ms. Ahmed would start insisting that the team approve such travel without her having done any of the necessary work she still needs to do on her smaller goals.
(o) Before the hospital can consider granting her international travel, three goals need to be achieved:
Take medication at regular times on time
Achieve the ability to return to hospital on time
Close communication by the family with the treatment team reporting on how community passes are going.
(p) Regarding the patient’s insight, Ms. Ahmed acknowledges she has a major mental illness and that medication helps. However, this is just a general understanding on her part. It is difficult to say whether her insight into psychotic episodes and the role of medication will improve. Regarding her insight into mood and sleep disturbance, this continues to develop.
- Dr. Hwang responded to questions posed by Board members.
(a) Asked about recent changes to the medication regimen, Dr. Hwang still believes the appropriate diagnosis is bipolar disorder with borderline personality.
(b) Before considering any possible travel to Mecca, Dr. Hwang needs to see longer successful stays out of hospital.
(c) The patient requires treatment with psychiatric medications. These are important for maintaining mental stability. The concern about rapid decompensation is still present given the history.
(d) It is positive to note how Ms. Ahmed has been mostly medication compliant over the past year. This is the main reason why the team has not seen any major behavioural episode during the current reporting period.
(e) Dr. Hwang was asked about the substitute decision-maker and the family’s cultural preference to only decide things on a unanimous basis. Dr. Hwang explained how this had led to paralysis in decision-making. Now that the treatment team and the niece have more of a working relationship, the concern has somewhat lessened.
(f) Ms. Ahmed’s brother was recently opposed to any placement in long term care. At one point earlier, he had expressed that Ms. Ahmed should stay in hospital indefinitely. It appears he may have since changed his position.
(g) Regarding family involvement in monitoring her medications, Ms. Ahmed has never had passes long enough for the family to be involved. So far, passes to the community have not exceeded eight hours on any given day.
(h) Ms. Ahmed takes her medications in oral form. Long-acting injectable medication has been offered to her several times, but Ms. Ahmed does not want it. The team would be more confident at considering international travel if long-acting injectable medication were accepted. This could be a motivator for Ms. Ahmed to consider. It is also the reason Dr. Hwang has kept oral Abilify on the list of prescribed medications.
(i) Ms. Ahmed has not travelled outside Ottawa during the current reporting period, nor did she do so previously, when she was on a less onerous conditional discharge.
(j) If Ms. Ahmed were to become stressed and irritable as before, concerns would arise about her ability to deal with airport security screening and being confined for long hours once airborne. Before international travel can be considered, the hospital needs to be satisfied that the family has been educated and equipped with a proper plan on how to deal with the various unexpected contingencies and possible disasters that can arise.
- The parties presented no further evidence.
Submissions of the Parties
The hospital representative advised that Ms. Ahmed has shown some improvement overall, including with medication compliance. It remains premature to consider any travel to Mecca. However, the hospital will continue to work hard to see if this could happen in the future. Depending on future progress, it may be that an early hearing could be sought to revisit the request for international travel.
Speaking for the Attorney-General, Ms. Dufort agreed with all aspects of the hospital recommendation. Ms. Ahmed first needs to progress to the stage of being able to enjoy overnight and then multi-night stays with family while getting well enough, over time, to eventually make a pilgrimage to Mecca. The evidence at present does not demonstrate such travel to be necessary or appropriate. It would be premature to provide Ms. Ahmed with anything more than what is already set out in the existing disposition.
Ms. Munsterman spoke on behalf of Ms. Ahmed. Counsel conceded the issue of significant threat. She agreed that a continued detention order on existing terms should continue. Counsel expressed hope that ongoing behavioral therapy will assist Ms. Ahmed in progressing further, so that she may spend more time out of hospital and eventually get out of hospital. Counsel acknowledged the frank discussion with Dr. Hwang about what is needed for Ms. Ahmed to be able to progress to the point of undertaking extended travel to Mecca.
Ms. Munsterman maintained the request for international travel on the usual terms, namely, to include a pre-approved itinerary and the requirement that Ms. Ahmed be accompanied by an approved person.
Observations and Conclusions
Based on the evidence, and supported by the appropriate joint submission, the Board finds that Ms. Ahmed continues to present a significant threat to the safety of the public. This is clearly established given the extensive behavioural and clinical history and indeed was not at all questioned by the parties.
In similar fashion, having regard to the joint submission and the evidence, a renewed detention order on the same terms is required to manage the risk presented. It is simply not possible to consider discharging Ms. Ahmed subject to conditions having regard to the many aspects of her physical, medical and mental health challenges. Moreover, it is not realistic to expect that Ms. Ahmed could even function outside the hospital setting, short of suitable placement in a highly structured and supportive care setting, such as in a Long-Term Care facility.
In more recent months, the hospital has had to revise their overall treatment plan. Efforts are ongoing to modify and reduce Ms. Ahmed’s list of prescribed psychiatric medications.
Just as importantly, her formal diagnosis now involves the added element of prominent borderline personality traits contributing to situational behavioural dysregulation. To deal with this, the treatment team and Dr. Hwang have only started to develop an individualized behavioural therapy approach to help Ms. Ahmed deal with her aggressive and violent outbursts. So far, while Ms. Ahmed has made some progress, considerably more time will be needed.
The Board views Ms. Ahmed’s request for international travel to Mecca with sympathy. One can easily understand how she must feel left out when her family members are able to make the pilgrimage, but she cannot.
That said, the Board finds it is not realistic to contemplate such travel at this time. Ms. Ahmed’s limitations and challenges are such that she has not managed to leave the hospital for more than eight hours on any given occasion. For the past few years, she has not managed to exercise a single overnight pass. Moreover, on those occasions when she does enjoy limited daytime and evening community access, she relies entirely on the support of others, most notably, family members.
The Board finds that any expansion of community access for Ms. Ahmed involving possible travel will first require her gaining the ability to successfully be absent from the hospital on an overnight basis. Depending on how she does, the hospital will then want to first have her attempt modest travel within Ottawa and Gatineau, and, if successful, to other points outside the immediate area.
Before any such modest attempts can even be contemplated, it is essential that a consistent and robust collaboration be established between the treatment team and Ms. Ahmed’s dedicated family members. The Board listened carefully to the evidence and submissions provided by Dr. Hwang and agrees with each of the points that were made. No doubt, both Dr. Hwang and the treatment team are willing and able to work with the family on this, while providing the family and Ms. Ahmed with further suggestions and encouragement in the months to come.
For these reasons, having regard to the primary protection of the public, and balancing Ms. Ahmed’s mental condition, her reintegration and other needs, a renewed detention order on the same terms and conditions will issue.
We thank the parties and counsel for their assistance.
DATED this 26th day of May 2026, at the City of Toronto, in the Toronto Region.
Mr. P. Hageraats
Alternate Chairperson
Office of the Registrar
Ontario Review Board