GUYSBOROUGH – As the Desmond Fatality Inquiry continued Monday in Guysborough, St. Martha's Hospital Psychiatrist Dr. Ian Slayter described apparent gaps in service when it came to the continued treatment of Cpl. Lionel Desmond after the former soldier left an Operational Stress Injuries (OSI) treatment centre in Montreal in August, 2016.
OSI is a mental health clinic available to veterans, and according to Slayter, by December 2016 Desmond had already been waiting for four months to receive their services out of Cape Breton.
Lawyer Tom Macdonald, representing the Borden family and sharing representation of Aaliyah Desmond, asked Slayter what transpired when he saw Desmond at the ER on Oct. 24, 2016.
“What I remember of that time -- and I remember a lot more of an impression than anything -- his wife did most of the talking and they were both somewhat emotional,” said Slayter. “His complaint was that he was having trouble sleeping because of nightmares and wanted some help with that. Along the way came the story that he was having PTSD types of symptoms such as flashbacks and the nightmares and so on.”
The psychiatrist said he also learned that there were frequent conflicts between the two. “It was quite clear that there was a lot of arguing going on between them,” he said. “There was some, a little bit I think, in the interview itself and they were talking about years of that going on.”
He said Lionel reported that the nightmares were sometimes related to his military experience, “but at that time, more of them related to nightmares that his wife was cheating on him and he would wake up angry or whatever about that, distressed,” he said. “And she was annoyed with him because he was often away when she expected he would be home from military deployments. And we talked a bit about that I think.”
Slayter described Desmond as "borderline delusional," in that he was not yet experiencing delusions, but was approaching the scope of delusion. His jealous thoughts about his wife were overvalued, not based in fact, Slayter said.
“But the underlying reason he was there was to get something done about his sleep, so I increased the medication that usually helps with nightmares and PTSD. I gave him something to help him sleep.”
Slayter said that during their conversation, Desmond described his responsibilities while deployed to Afghanistan. His work largely included retrieving bodies, often at night, while staying alert for landmines and overhead fire. Slayter called the memories Desmond shared with him as "horrific." He also raised his concerns about three falls Desmond experienced during his tour that resulted in head injuries.
Macdonald asked Slayter what might help, in his field, to prevent this kind of tragedy from being repeated.
“I think that some education on domestic violence, but particularly on serious violence and homicide would be helpful,” said Slayter. “These are forensic psychiatry issues which most of us don't get any training in and don't have any experience in. I've never had someone who shot someone before in my career. So I think getting some help and learning how to identify the red flags for that kind of thing would be helpful.”
Slayter’s assessment of Desmond was that he experienced intense emotions, depression and a history of trauma, but noted that he did not think that he was at risk of doing harm to himself or others in the near future.
A follow-up appointment with Slayter was scheduled for Dec. 2, 2016, however, on Dec. 1 Desmond presented to the ER at St. Martha’s to seek help with his mental health, telling the triage nurse he was experiencing problems at home, including his frequent outbursts and a temporary separation from his wife. Desmond was triaged at 11:28 a.m., but a note submitted as evidence to the Inquiry reported that by 3:10 p.m. Desmond was no longer in the waiting room.
He attended his scheduled appointment the following day but did not disclose his visit to the ER to Slayter.
Inquiry counsellor Allen Murray asked Slayter what he thought Desmond needed in terms of services.
“I thought he needed more trauma therapy,” he replied, continuing, “I felt bad for him, he seemed to feel a bit let go with what he was getting and what he wasn’t getting. He had put his life on the line, he deserved to get the full service that the military could provide.”
At the time, Slayter was not optimistic that Desmond would be receiving services from OSI any time in the near future. Counselor Tom Macdonald ask him why he thought that, to which Slayter replied, “For many of us working in healthcare, it’s the impression that the province and health authority don’t have a lot of money to spend on new things.”
According to Slayter, Desmond was told that he would be able to access OSI services in Cape Breton, although a clinic hadn’t been set up yet. Offering his perspective on the OSI process in Desmond’s case, Slayter stated, "I thought it could be organized better, he needed it, he deserved it."
When it came to Desmond’s treatment and access to services, healthcare providers were working in silos divided by regional, provincial and federal jurisdictions, the Inquiry heard.
The Inquiry is exploring a variety of issues related to the tragedy of Jan. 3, 2017 in Upper Big Tracadie, when Lionel Desmond shot and killed his wife Shanna, 10-year-old daughter Aaliyah and his mother Brenda before taking his own life.