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Lionel Desmond, his wife Shanna and daughter Aaliyah.

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A former Canadian soldier who killed three family members and himself in 2017 received sporadic mental health treatment immediately after he left the military in 2015, a fatality inquiry heard Thursday.

The provincial inquiry in Nova Scotia learned the Canadian Armed Forces had arranged for therapy to continue for Lionel Desmond after he was medically discharged. But the lack of structure outside the military created new challenges for the mentally ill veteran of the war in Afghanistan.

Psychologist Mathieu Murgatroyd, who worked at the Operational Stress Injury Clinic in Fredericton, was tasked with providing the former corporal with treatment from June 2015 to October 2016.

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The psychologist said there were problems from the start because Desmond, then 32, often cancelled appointments or didn’t show up.

Plans for therapy were derailed by the fact that Desmond spent much of his time travelling between New Brunswick and Nova Scotia, where he was trying to re-establish a relationship with his wife, Shanna, and his young daughter, Aaliyah.

“In terms of commitment and engagement, it was interfering with the therapy process,” Murgatroyd testified. “We were concerned with this inconsistency.”

Murgatroyd said it was clear Desmond needed help.

In 2011, while posted to Canadian Forces Base Gagetown in New Brunswick, Desmond was diagnosed with post-traumatic stress disorder and major depression. That was four years after he served as a rifleman during a particularly violent tour of duty in Afghanistan.

Earlier this week, mental health professionals contracted by the military told the inquiry that Desmond initially responded well to treatment, but that he suffered a relapse in May 2013 when military colleagues subjected him to racist comments about his African Nova Scotian heritage.

Murgatroyd testified that Desmond appeared guarded and distant when they first met in June 2015 at the federally funded clinic, which receives referrals from the Department of National Defence, Veterans Affairs Canada and the RCMP.

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“Based on his presentation, the risk was more elevated in terms of spiralling down,” Murgatroyd said.

As well, he said Desmond made it clear his relationship with his wife, Shanna, was in turmoil. “There were moments when they seemed to be doing better, but for the most part, strained,” he said, adding that Desmond had increased his alcohol consumption to deal with stress.

Murgatroyd recalled that during their first treatment session, Desmond complained about nightmares, night sweats, daily intrusive thoughts, disturbed sleep, chronic pain and “homicidal thoughts without intent.”

“He hardly gets out of his house because of his paranoia,” Murgatroyd noted after an early therapy session in 2015.

Desmond said he had suffered a number of head injuries while serving in the military, and that he worried about a possible brain injury. The inquiry has heard the former corporal did not disclose this concern while he was in the military.

Though Desmond was under Murgatroyd’s care for 16 months, the psychologist said his therapeutic plan never got off the ground. “We were just putting out fires rather than working on any real intervention,” he said.

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He said it appeared Desmond’s source of psychological distress eventually shifted from his combat-related PTSD symptoms to an angry “fixation” with his wife’s handling of their finances and concerns that she may be cheating on him.

Murgatroyd said Desmond told him about gruesome nightmares he had that suggested his wife had been sleeping with another man, whose head was later found on the floor.

The psychologist agreed when asked if Desmond’s dreams were having an impact on his perception of reality. Murgatroyd said that helped explain why Desmond would later revoke his consent to allow the clinic to share information with his wife.

Eventually, staff at the clinic decided therapy for Desmond wasn’t an option until he was properly stabilized. They recommended he should take part in an intensive treatment program at Ste. Anne’s hospital in Montreal, which has an in-patient operational stress injury clinic.

By April 2016, Desmond had agreed to go to Ste. Anne’s, having recognized that his relationship with his wife was deteriorating amid talk of divorce, Murgatroyd said.

The following month, Desmond reached “an all-time low,” Murgatroyd said, adding that his patient was distressed about the state of his finances and the idea his wife was manipulative and could not be trusted. “With things spiralling down, he was looking for help.”

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Desmond arrived at St. Anne’s on May 30, 2016, but he left less than three months into a six-month program, even though he had reported he was enjoying his stay there, Murgatroyd said.

The inquiry has heard that Desmond returned home to Upper Big Tracadie, N.S., in August 2016.

Evidence presented to the inquiry has shown Desmond received no therapeutic treatment for the next four months, even though Murgatroyd and Veterans Affairs Canada were making arrangements for treatment in Nova Scotia.

Staff at Ste. Anne’s had recommended Desmond receive an in-depth neuropsychological assessment and more treatment, but that never happened.

On Jan. 3, 2017, Desmond bought a semi-automatic rifle. Later that day, he fatally shot his 31-year-old wife, their 10-year-daughter and his 52-year-old mother, Brenda, before killing himself in the family’s home.

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