Lionel Desmond fell through cracks of health care system – psychiatrist

GUYSBOROUGH: The first civilian psychiatrist to meet with retired Cpl. Lionel Desmond after he was released from the military’s care testified Monday at the fatality inquiry looking into what caused him to kill his mother, wife, daughter and himself, that the Afghanistan war veteran’s complex mental illness deteriorated “due to a gap in treatment.”

Dr. Ian Slayter, who assessed the 33-year-old on two separate occasions in the fall of 2016, told the inquiry the former rifleman displayed symptoms of post-traumatic stress disorder (PTSD) – but his mental health issues were far more complex – as he was also suffering from major depression, a probable traumatic brain injury, possible attention deficit disorder (ADD) and was “borderline delusional.”

“He was complex in terms of having several diagnoses going on at the same time,” he told the inquiry.

Slayter, who is a psychiatrist at the out-patient clinic at St. Martha’s Regional Hospital in Antigonish, has extensive experience studying suicide. Alongside his colleagues in 2010, he helped design a suicide risk assessment tool – which is why he considered Lionel a “low risk” in late 2016 and early 2017.

“There were no red flags.”

Dr. Slayter said he was “surprised and horrified” when he learned Lionel shot and killed his mother Brenda, wife Shanna, and 10-year-old daughter Aaliyah before taking his own life.

He testified his first interaction with Lionel occurred in an emergency room visit on October 24, 2016 as Lionel was unable to leave the trauma and memory of combat behind, and was experiencing persistent problems with sleeping and nightmare – his wife did most of the talking.

“I thought he needed more trauma therapy, I felt bad for him – he seemed to be let go from what he was getting and wasn’t getting and he was having a hard time, his wife was having a hard time,” Dr. Slayter told the inquiry. “And I thought he put his life on the line for people [and] that he deserved to get the full service the military [or] Veterans Affairs could provide.”

Lionel informed the psychiatrist, while his PTSD symptoms were dwindling, his jealousy towards his wife Shanna and nightmares about her infidelity had progressively been getting worse.

“His nightmares would sometimes relate to his military experiences, but at that time more [so] related to nightmares that his wife was cheating on him, and he would wake up angry or distressed,” Dr. Slayter suggested. “Clearly, jealousy was one of the problems – but the important thing for me was he said and [Shanna] said he never hit her or was physically violent towards her and she said she wasn’t afraid of him.”

However, Dr. Slayter testified he wasn’t informed about an incident a year prior in New Brunswick when Lionel was suicidal and police had to intervene.

Through their first interaction, Dr. Slayter determined the former infantryman had not received any therapy since returning home from the Quebec-based, in-patient treatment centre for veterans suffering from PTSD, at Ste. Anne’s Hospital in August.

Suggesting Lionel was “falling through the cracks” after returning home to Nova Scotia when the care he’d been receiving through the federal Veterans Affairs Department when he was living in New Brunswick stopped his services, Dr. Slayter told the inquiry that gap created barriers in accessing his medical records.

“I would like an easy way to access OSI services, Veterans Affairs records, and military records,” he said. “I thought it could be organized better. He deserved it.”

Melissa Grant, a lawyer representing the Attorney General of Canada, informed Dr. Slayter that Lionel had a case manager within Veterans Affairs who was assisting him on locating the services he desperately needed – except, there were issues surrounding the location of receiving the treatment – Halifax or Cape Breton.

Dr. Slayter testified he believed Lionel deserved a higher level of care – and agreed to meet with him until he received treatment through the military or Veterans Affairs.

“He spent seven months in Afghanistan… and he described his main role as retrieving bodies,” Dr. 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.”

During a follow-up psychiatric assessment on December 2, 2016, that lasted approximately two-hours, Dr. Slayter concluded Lionel was prone to angry outbursts and his jealousy seemed “over-emphasized” and “bordering on delusional” but didn’t see anything concerning.

Dr. Slayter testified Lionel would benefit from a neuro-cognitive assessment to determine if he had a brain injury, and to see if that was the cause of his problems processing information or difficulty following instructions or long conversations.

He never got the chance to as Lionel didn’t attend their follow-up appointment on December 21, 2016. Lionel did however book another appointment with Dr. Slayter on January 3, 2017, but later that day, he carried out the tragic triple murder-suicide in his wife’s family home in Upper Big Tracadie.

Dr. Slayter wanted Lionel to receive help from an occupational stress injury clinic but before those services could be arranged, he asked Lionel to obtain his medical records from the Canadian Forces and Veterans Affairs, something he admitted would be difficult for Lionel to accomplish.

Tara Miller, the lawyer representing Lionel’s sister Chantel, suggested the lack of communication could have been a barrier to Lionel’s care.

“You’re both essentially working in the same direction but you’re in silos,” she said. “So we have all of these folks who are trying to help Cpl. Desmond… and nobody’s able to share the information.”

Dr. Slayter recommended to Provincial Court Judge Warren Zimmer that it’s crucial to make the access to medical records from the military easier. Doctors can obtain medical records from any civilian hospital across the country within a day, but Dr. Slayter suggested there’s no easy path to get one’s information from the military.

Adam Rodgers, the lawyer representing Lionel’s estate, said it was impossible for Lionel to obtain those records.

“In practical terms, it was impossible to get those records, Cpl. Desmond was going to be responsible to get those himself, and we heard Dr. Slayter say… to [Lionel] it would have been inconceivable complex,” he said. “And that is really an unfair burden to put on a soldier.”

The inquiry has heard previous evidence about the benefits of moving to a “One Patient One Record” system of keeping medical records.