Gaps in treatment affected Afghanistan veteran's PTSD before fatal shootings: psychiatrist

The first civilian psychiatrist to meet Lionel Desmond after he was released from the military's care testified on Monday that the veteran's complex mental illness likely worsened due to a gap in treatment.

When Dr. Ian Slayter met Desmond on Oct. 24, 2016, there was no sign that the Afghanistan vet and former sniper had gotten any therapy since leaving an in-patient treatment for post-traumatic stress disorder in Montreal in August. 

But persistent problems with sleeping, nightmares and "borderline delusional thoughts," drove the 33-year-old to try to find help at the emergency room in Antigonish, N.S., that day, Slayter told the inquiry into Desmond's death. 

The inquiry has spent nearly a week focused on what treatment Desmond received in the months leading up to Jan. 3, 2017, when he shot his wife Shanna, his mother Brenda, and his daughter Aaliyah, in his wife's family home. 

He then turned the gun on himself. 

Slayter testified that the Desmond he met — twice, in October and again in December — showed no sign that he would harm himself or anyone else. Slayter said Desmond seemed subdued and unkempt.

It's a stark contrast to the picture of the affable and well-groomed man that Dr. Faisal Rahman testified about last week, in describing meeting Desmond just days before the fatal shootings in Upper Big Tracadie, N.S.

But Slayter also testified that he thought Desmond needed a higher level of care.

"He spent seven months in Afghanistan ... and he described his main role as retrieving bodies," Slayter said. "He was often under fire, watching out for landmines, he couldn't see very well —  and [he'd be] retrieving bodies. 

"He had a lot of horrific memories of that."

Desmond was also, Slayter testified, prone to angry outbursts and described jealous nightmares that were "bordering on delusional," but Slater said he didn't see anything he deemed dangerous.  

In earlier years, the inquiry has heard, Desmond's memories had played out in nightmares and flashbacks. But by late 2016 the focus of the nightmares had shifted, Desmond told Slayter, to dreams about his wife cheating on him — something of which Slayter said there was no evidence. 

"It also came out that [Desmond] would get angry at times and he would pound tables and throw things … but [his wife] said — and he said — that he had never hit her and she wasn't afraid of him." 

Slayter said he wanted to help Desmond and agreed to meet with him until he got treatment through the military or veterans affairs. 

The two met on Dec. 2, 2016, for a full assessment that lasted about to two hours. Slayter described Desmond as "having clear-cut PTSD," major depressive disorder and showed signs of post-concussion syndrome. 

He told the inquiry that Desmond needed intensive trauma therapy to recover and would benefit from a neuro-cognitive assessment to see if he had a brain injury — and whether that was also what was affecting his concentration, his memory and his ability to do more than one task at a time. 

Beyond that, he felt Desmond might have Attention Deficit Disorder and he also wanted to probe the issues of jealousy further. 

He never got the chance.

Desmond didn't show up for their follow-up appointment later that month. And, although, he made another appointment with Slayter on Jan. 3, the tragedy at the heart of this inquiry happened later that day. 

When asked what psychiatrists and crisis care workers might benefit from in cases like this, Slayter suggested that both better training in spotting the signs of domestic violence — and forensic psychiatric training, which looks at the intersection of mental health and criminal behaviour. 

He also told Judge Warren Zimmer that it's critical to make it easier to access medical records from the military; Slayter said he can get records from any civilian hospital in Canada within a day, but there's no easy path to get information from the military.

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