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Veterans Affairs neglected to give key information to the psychotherapist it appointed to treat Lionel Desmond after his release from an intensive PTSD clinic, which would have informed her of the severity of his mental-health issues and connected him with appropriate treatment sooner.

This lack of communication regarding Mr. Desmond’s medical history is a crucial example of a recurring theme that has emerged over the course of the provincial fatality inquiry, which began Jan. 27 in Guysborough, N.S. The inquiry is examining whether Mr. Desmond, a former infantry soldier and Afghanistan war veteran, and his family had access to adequate mental-health and domestic violence-intervention services leading up to the triple murder-suicide in rural northeastern Nova Scotia on Jan. 3, 2017.

Catherine Chambers, the Veterans Affairs-appointed psychotherapist, said Thursday if she had been given documents about Mr. Desmond’s previous treatment and recommendations for his continuity of care, she would have directed him to in-patient care for post-traumatic stress disorder (PTSD) instead of agreeing to assess him. The former soldier’s medical history was supposed to be provided by his Veterans Affairs Canada (VAC) case manager, Marie Doucet.

A month after Ms. Chambers first met with Mr. Desmond, he shot and killed his wife Shanna, mother Brenda, 10-year-old daughter Aaliya and then himself in his wife’s family home.

The lack of medical information sharing has been a recurring theme over the course of the provincial fatality inquiry, which began on Jan. 27. Thursday marked the end of testimony examining how Nova Scotia health-care providers treated Mr. Desmond, oftentimes in silos without a continuous record of his history in VAC-funded operational stress injury clinics and without knowledge of how to obtain military medical records.

The past two days have provided the first glimpses into how Veterans Affairs was dealing with Mr. Desmond in the weeks preceding the deaths, leading Justice Warren Zimmer, who is presiding over the inquiry, to agree with psychiatrist Ian Slayter’s earlier assessment that VAC seemed to be allowing the Afghan war veteran to fall “through the cracks in terms of follow up by military and veteran programs.”

Justice Zimmer has heard over the past three weeks how Mr. Desmond was adrift while trying to seek help from various mental-health providers while in crisis for severe depression and PTSD. The vet showed up repeatedly at the local hospital emergency room, where public health professionals noted he was becoming increasingly angry and jealous toward his wife, he couldn’t sleep, and his mental-health issues seemed far more complex than one diagnosis. He met with Ms. Chambers for two, hour-long sessions where he expressed frequent suicidal ideation, saying he wished he’d just been blown up in Afghanistan.

Ms. Chambers began to sob as Justice Zimmer read from documents summarizing Mr. Desmond’s diagnosis and recommendations from other clinicians who had treated the vet for six weeks in the summer of 2016 at the VAC-funded Ste. Anne OSI clinic in Montreal. It was the first time she had ever heard the details.

“It’s important to appreciate that all of this information was sitting there and you had none of it,” Justice Zimmer said. “So it’s important for people to understand all that was available and the impact that it had.”

According to Veterans Affairs case manager Ms. Doucet’s notes made near the time of his Aug. 15, 2016, discharge from the in-patient clinic in Montreal, he had cognitive limitations and needed a neuro-psychological assessment. She noted concerns about lack of a sound plan for his coming discharge, that he was headed to Nova Scotia and required support – none of which was relayed to Ms. Chambers who said it was crucial to have, adding that without cognitive wellness, psychotherapy treatment is ineffective.

Justice Zimmer noted that there appeared to be no continuity of care between Mr. Desmond’s release from the OSI clinic in Montreal in August, 2016, until November, when he first spoke on the phone to make an appointment with Ms. Chambers.

“Would you agree with me that’s a big gap … for a person coming out of a residential treatment facility with a follow-up plan … and then go to nothing?” Justice Zimmer asked Ms. Chambers.

“Yes, I would agree with you,” she replied.

Hours before the murders, Mr. Desmond called Ms. Chambers to confirm an appointment for two days later. They spoke for 26 minutes as she noted Mr. Desmond was in crisis, describing how he ran a vehicle off the road on New Year’s Eve, which led to a heated argument with his wife. He told Ms. Chambers his wife wanted a divorce. On the phone, Mr. Desmond was stressed about where he was going to live and how he was going to pay for it, but had no suicidal ideation and agreed to a plan to go to the emergency room if his status changed, Ms. Chambers testified.

When lawyer Tara Miller raised the idea that Mr. Desmond may have disassociated leading up to the triple-murder suicide, Ms. Chambers agreed it is a possibility. Disassociation is when the brain involuntarily disconnects from reality when a person is overwhelmed in their ability to cope with something stressful or traumatic – which, in Mr. Desmond’s case, might have been the car accident, divorce or change in living situation, Ms. Chambers said. In times of disassociation, a person may act completely out of character.

The inquiry reconvenes Feb. 18.

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