Psychiatrist questioned about 'red flags' before Lionel Desmond's release from hospital, inquiry hears

Dr. Faisal Rahman remembers Lionel Desmond as a calm, well-spoken and well-groomed veteran of the Afghanistan war. 

The psychiatrist said the man he interviewed in the emergency room on Jan. 1, 2017, gave no sign he planned to hurt himself or anyone in his life.  

That's why after a one-night stay at St. Martha's Regional Hospital in Antigonish, N.S. the former sniper got discharged on Rahman's approval. 

At that point, he'd already begun some of the 90 searches police found on his cellphone for weapons and where to buy them. 

And on Jan. 3, he fatally shot his wife, Shanna, 10-year-old daughter, Aaliyah, and his mother, Brenda, at a mobile home in Upper Big Tracadie. He then turned the gun on himself.

The CBC's Laura Fraser liveblogged from the fatality inquiry in Guysborough, N.S.

'Red flags'

Rahman faced more than an hour of cross-examination from the lawyer representing Shanna Desmond's family — which centred on the idea that he missed warning signs of violence. 

Tom Macdonald repeatedly asked Rahman why he didn't consider Desmond's combat history, his post-traumatic stress disorder diagnosis or his admission that his wife had called the police on him numerous times as "red flags." 

Rahman did not fully answer the question at first. 

Instead, he told the inquiry that he made a clinical assessment and found Desmond's demeanour, body language and ability to make plans for the future all to be positive signs.

Macdonald pressed the point, however, asking Rahman why he didn't consider it concerning when Desmond told him that police had seized his gun in the past and that his wife had just asked him to leave.

The fatality inquiry's mandate includes learning more about Desmond's release from hospital and whether the doctors who treated him were trained to understand the symptoms and effects of post-traumatic stress disorder.

Desmond's medical chart reported that he had PTSD, post-concussion syndrome and was "having a bad day," the inquiry heard Monday. Shanna Desmond had asked him to leave her family home the night before after he'd spent hours yelling and breaking furniture. 

But when Rahman met Desmond for about 30 to 40 minutes, he said he found the veteran's symptoms weren't a result of his PTSD or depression.

Instead, he felt Desmond was distressed about his relationship with his wife and "their long-standing conflict," he said. During the mental health assessment, Desmond told the psychiatrist that fights had riddled his relationship with Shanna and that, each time, she would call the police and ask him to leave.

Rahman said that Desmond seemed frustrated that his wife kept involving police, but stayed calm as he talked. The couple's latest fight had begun on New Year's Eve when he became irate after rolling a truck into the ditch, Rahman said, an incident police have described as the catalyst to the entire tragedy. 

"He told me [the fight] just kept escalating until the next morning," Rahman said. "He punched the table or some piece of furniture and he startled his daughter."

Risk factors

But although Desmond had shown aggression during the fight, Rahman said that he seemed remorseful — and regretted upsetting his daughter. 

He talked happily about Aaliyah's 10th birthday party and the plans he had for his future. Desmond was being followed by another psychiatrist at St. Martha's as well as a social worker through Veterans Affairs. 

All of those things — what Rahman called "protective factors" — combined with Desmond's calm and forthcoming demeanour convinced the psychiatrist the veteran wasn't a risk to himself or anyone else.

He found the "protective factors" outweighed the risks: Desmond's lengthy history of mental illness, his relationship conflict and his prior thoughts of suicide. 

Overnight stay

Although Rahman felt Desmond was not acutely ill, he agreed to keep the former soldier overnight as a "social admission" at Desmond's request since his wife had asked him to stay somewhere else.

Two accounts about that overnight stay have emerged throughout the inquiry, with Desmond having told family that the psychiatric ward was full, and staff at St. Martha's saying the veteran asked not to be put in that ward because his wife worked there.

Rahman upheld the latter, saying that Desmond was given a comfortable bed in the emergency room at his request and not a stretcher. He told the inquiry that he offered the veteran a second night's stay if he wanted.

Prevention

The Afghan War veteran had been diagnosed by a Department of National Defence psychiatrist in 2011. He received treatment while in the military in New Brunswick and, later, in Quebec.

He sought help in Nova Scotia as well, but previous witnesses have questioned whether his civilian doctors could access his military records to understand the full scope of Desmond's illness. 

The purpose of the inquiry is to examine whether changes to public policy — in health care and supports for veterans and their families — can prevent similar deaths. It is, however, a provincial inquiry and doesn't have the jurisdiction to recommend changes to key federal departments, like National Defence and Veterans Affairs.