Lack of follow-up care led to 'serious' decline in veteran who killed family, himself: judge

The Afghanistanveteran with severe post-traumatic stress disorder who killed his family and himself within four months of leaving an in-patient psychiatric program would have needed follow-up care to stay healthy, the Lionel Desmond fatality inquiry heard Wednesday.

The occupational therapist who saw Desmond during the two-and-a-half months he spent at Ste. Anne's Hospital in the summer of 2016 called continuity of care "essential" to a client's well-being when she spoke via video link to the courtroom in Port Hawkesbury, N.S.

Judge Warren Zimmer agreed with the witness.

He noted that the psychiatrist who saw Desmond at an emergency room in Antigonish, N.S., on Oct. 24, 2016, found him to be significantly ill this, after having had no follow-up care since being discharged from the Montreal program more than two months prior.

The CBC's Laura Fraser is liveblogging the inquiry:

Zimmer read through the symptoms Dr. Ian Slayter reported that Desmond was experiencing that day: he couldn't sleep, he was having nightmares and night sweats and had no appetite. He felt angry, struggled with aggression, would get overwhelmed and continued to have paranoid thoughts about his wife and was distrustful of others.

"He was experiencing anxiety, depression, he had trouble adjusting after returning from the military," Zimmer said.

"When you look at how he presented (it) suggests to me that there was a substantial and serious degradation in mental health from August15to October24," he said.

When he asked the witness whether she agreed, Julie Beauchesne nodded and said she did.

Zimmer has repeatedly returned to this issue in his comments at the inquiry.

Evidence from the six different doctors Desmond saw between the time he returned to Nova Scotia and the triple-murder suicide on Jan. 3, 2017, also underscored the significance that the lack of follow-up care had on the former soldier's mental stability.

That transition from the military health system to civiliancare is an issue about which Zimmer is expected to make recommendations in order to prevent further deaths like those of Desmond's wife, Shanna, his mother Brenda, his daughter, Aaliyah, 10, and Desmond himself.

Desmond showed cognitive impairment: witness

JulieBeauchesne, an occupational therapist and a clinical coordinator, worked with Desmond during his time at Ste. Anne's, focusing especially on developing the skills he would need to overcome the ways in which his PTSD symptoms affected his home andworking life.

In her final discharge report, Beauchesne had recommended that Desmond'steam in the community arrange for an occupational therapist or a social worker to do a "functional assessment" of him at home.

The purpose of that assessment would be to see how he copes in his everyday environment rather than in the structure of an in-patient program to fine-tune the support he might need, she testified.

Beauchesne and the rest of the team at Ste. Anne's had also recommended that Desmond get a neurocognitive assessment done. Some of his symptoms, like how quickly he could become frustrated and his difficulty in concentrating, suggested the possibility of a cognitive impairment, coupled with his report that he'd suffered at least two or three concussions during training and in combat in Afghanistan.

The occupational therapist administered a 30-question test that found Desmond did have a "mild cognitive impairment." But she said that more testing would need to be done to find out the cause: it could be anything from his medication, to his depression and PTSD, or an underlying neurological or head trauma.

Neither the functional assessment nor the neurocognitive one were done before the fatal shootings.

The fact that the psychiatrist and psychologist treating Desmond were in New Brunswick where he'd lived while serving at CFB Gagetown and after his release appears to have been a key factor in his gap in services after leaving the Montreal hospital.

He chose not to return to New Brunswick, but instead to move back with his family in Nova Scotia, something that a lawyer for Veterans Affairs noted was his choice and not that of his treating team.