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The Desmond Fatality Inquiry is being held in Guysborough, N.S.Andrew Vaughan/The Canadian Press

A psychiatrist who saw Lionel Desmond twice before he killed his family and himself in 2017 told an inquiry Monday the former soldier displayed symptoms of post-traumatic stress disorder, but his mental health issues were far more complex than the one diagnosis.

Dr. Ian Slayter, who assessed Mr. Desmond during two meetings in the fall of 2016, told the fatality inquiry that the Afghanistan war veteran from rural Nova Scotia also suffered from major depression, a probable traumatic brain injury, possible attention deficit disorder and borderline delusions about his wife’s fidelity.

“He was complex in terms of having several diagnoses going on at the same time,” Dr. Slayter told the inquiry, which has held eight days of hearings.

The psychiatrist, who works at the outpatient clinic at St. Martha’s Regional Hospital in Antigonish, N.S., said Mr. Desmond told him his PTSD symptoms had been subsiding but he said his jealousy toward his wife Shanna and nightmares about infidelity had been getting worse.

“Clearly, jealousy was one of the problems,” Dr. Slayter said. “I didn’t spend a lot of time going into that … They seemed irritated with each other.”

Dr. Slayter said when he first met Mr. Desmond during an emergency room visit on Oct. 24, 2016, Shanna was with him and did most of the talking, saying at one point she was not afraid of him, though she confirmed there had been a great deal of marital conflict.

“It’s clear there had been a lot of arguing,” Dr. Slayter testified. “They were talking about years of that going on … He would get angry, pound on tables and throw things.”

Mr. Desmond, who at the time mainly complained about nightmares and lack of sleep, insisted he had never physically abused his wife.

During a follow-up psychiatric assessment on Dec. 2, 2016, Dr. Slayter concluded Mr. Desmond’s jealousy seemed “overemphasized” and “bordering on delusional,” he said.

Dr. Slayter said Mr. Desmond, 33, also had problems processing information and complained about having difficulty following instructions or long conversations. Those symptoms could have been linked to a possible traumatic brain injury caused by one of three serious falls he had while serving in Afghanistan in 2007, he said.

On Jan. 3, 2017, Mr. Desmond used a Soviet-era SKS 7.62 semi-automatic carbine to kill his 52-year-old mother Brenda, his 31-year-old wife and their 10-year-old daughter Aaliya inside the family’s mobile home in Upper Big Tracadie, N.S.

Dr. Slayter told the inquiry he was worried Mr. Desmond was “falling through the cracks” because he had been receiving care through the federal Veterans Affairs Department when he was living in New Brunswick, but those services stopped when he moved to Nova Scotia.

“I thought it could be organized better,” he said. “He deserved it.”

Melissa Grant, a lawyer representing the attorney general of Canada, told Slayter that Mr. Desmond had a case manager within Veterans Affairs who was working on finding him the services he needed, but there was some dispute over where he would have to go – Halifax or Cape Breton.

The inquiry has heard that Mr. Desmond failed to show up for an appointment with Slayter on Dec. 21, 2016, but on Jan. 3, 2017 – the same day as the killings – he booked another appointment for later in the month.

Dr. Slayter was the third medical professional to testify that Mr. Desmond was articulate, calm, coherent and showed no signs of psychosis or thoughts of suicide or homicide, which is why he was considered a low risk for violence in late 2016 and early 2017.

“There were no red flags,” Dr. Slayter said.

However, he said he was not told about an incident a year earlier in New Brunswick when Mr. Desmond threatened suicide and the police were called in.

Dr. Slayter said he wanted Mr. Desmond to get help from an occupational stress injury clinic and to undergo a specialized neuropsychological assessment, which would examine the extent of his possible brain injury.

But before those services could be arranged, he asked Mr. Desmond to obtain his medical records from the Canadian Armed Forces and Veterans Affairs, something Dr. Slayter admitted would be difficult for Mr. Desmond to accomplish.

Mr. Desmond told the psychiatrist he had an upcoming appointment with a Veterans Affairs therapist, but Dr. Slayter confirmed he did not exchange information with her.

Tara Miller, who represents Mr. Desmond’s sister, Chantel, suggested the lack of communication could have been a barrier to Mr. Desmond’s care.

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

Dr. Slayter agreed.

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