'We can't go back,' says doctor at hospital linked to veteran in murder-suicide

An emergency room doctor at the hospital accused of turning away a Canadian Forces veteran the day before he killed himself and his family, says hospitals in rural Nova Scotia are desperate for more mental health services.

Dr. Maureen Allen, who works at St. Martha's Regional Hospital in Antigonish, N.S., was not involved in Lionel Desmond's case and can't discuss specifics of what happened with him at the facility. 

But she says she welcomes the investigation announced Thursday by Nova Scotia Health Minister Leo Glavine into what contact Desmond had with the provincial health-care system.

"We can't go back. I know that every one of us would like to go back and change this outcome but we can't," Allen said in an interview. "So how do we find the strength within ourselves to move forward, but also to help this family move forward. It needs to be looked at very carefully." 

Family found dead

Shanna Desmond, 31, Brenda Desmond, 52, and 10-year-old Aaliyah Desmond were found dead in their Upper Big Tracadie, N.S., home Tuesday night. Lionel Desmond shot them before taking his own life, RCMP confirmed Friday.  

Family members have said Lionel Desmond had post-traumatic stress disorder related to a tour in Afghanistan. He was released from the military in 2015 and spent time at a Montreal clinic.

Family members say he sought mental health help at St. Martha's before the killings. One member says he was turned away because there were no beds, another says it was because they didn't have his file. 

The Health Department and Nova Scotia Health Authority "are gathering information internally so we have a better understanding of what may or may not have happened," Health Minister Leo Glavine said in a statement issued Friday. 

'Need much greater than I can provide'

Glavine said he's working with Dr. Linda Courey, the health authority's senior director of health and addictions, but they are "bound by privacy legislation and cannot provide personal details."

• Province to review after hospital accused of turning away veteran and the 'monster' inside him

Allen said emergency rooms like the one she works in "are inundated" with people struggling with mental health and addictions issues, particularly on weekends and during the evening hours.

"I'm a physician who is trained to do emergencies, who is trained to sit with patients, but the kind of care these patients need is much greater than I can provide for them," she said.

"There's no question there needs to be some sort of flexibility and change within the system. Patients who come to us after hours and on weekends are really at the disposal of the resources of the emergency department." 

Assessing people in crisis

St. Martha's mental health crisis worker only is accessible 9 a.m. to 4 p.m., Allen said. Psychiatrists on staff are on call after hours, but she said it often falls to emergency room physicians who are "pulled in many directions" and family physicians to assess a distressed person's mental state. 

There are specific screening processes for people who have visited the emergency rooms several times, but it can be harder to determine the extent of a mental health crisis during a patient's first visit, Allen said. 

Physicians must evaluate whether a patient is a danger to themselves or others. This may involve talking to a person's family and assessing if a patient is capable of making decisions related to their own care. 

"You can screen out all of that and still have a terrible outcome. So how can we change that screening?" she said. 

Preventing future deaths

Screening takes time and sitting down to talk in the "very chaotic and unpredictable" environment of an emergency room is often not the best option for a patient, Allen said.

Under an amalgamated provincial health authority, Allen said the Antigonish hospital no longer has a dedicated "pocket of money" to allocate for specific services, such as more mental health care.

Instead, she said it's now competing with needs from across the province.

"You feel like you've been forgotten, that we have no voice, that we're losing our autonomy," she said

Allen calls the volume of patients she sees from Pictou to Inverness as the "canary in the coal mine" of the health-care system — setting off alarms that people with mental health and addictions issues are not getting access to the treatment they need.

"From my perspective there are many examples in health care where we've let families and patients down, that we need to be able to step back and say how can we prevent this in the future and how can we learn from this process?"