The violent and persistent nightmares that an Afghanistan veteran disclosed about his wife in the years before he killed her in a triple murder-suicide signalled that Lionel Desmond was at "the severe end of the spectrum" when it came to persistent homicidal thoughts, a forensic psychiatrist told a fatality inquiry Monday.
Dr. Scott Theriault testified as an expert at the inquiry in Port Hawkesbury, N.S., which is looking at whether changes to government departments and public institutions might prevent future deaths like those of the Desmond family.
On Jan. 3, 2017, Desmond fatally shot his wife, Shanna; their 10-year-old daughter, Aaliyah; and his mother, Brenda, before turning the gun on himself.
He had been released less than five months prior from a psychiatric in-patient program for veterans in Montreal. His treatment team at Ste. Anne's Hospital has testified he made only minor improvements in stabilizing some of the symptoms of his complex post-traumatic stress disorder, including his ability to regulate anger.
Theriault, a forensic psychiatrist with 30 years of clinical practise, performed a psychological autopsy on Desmond — a review of how his mental illness affected his decision-making at the time of his death.
Theriault agreed Desmond didn't fully stabilize at Ste. Anne's Hospital and noted the veteran would have declined after that, due in part to the fact he received no therapeutic treatment after his discharge.
But the forensic psychiatrist also testified Desmond's symptoms seemed to be related to more than just the PTSD and major depression that he'd been diagnosed with in 2007.
The disclosures the former soldier made to a psychologist in 2015 about persistent dreams of his wife being unfaithful included violent imagery of him stabbing her and the man involved. Theriault noted the psychologist felt that these paranoid and homicidal thoughts were affecting Desmond on an almost daily basis.
"I've seen cases of a similar nature over the years, where it's been a case of domestic violence and that includes murder, but the intensity and frequency of those thoughts … wouldn't be as intense as the information I have about Mr. Desmond," Theriault told the inquiry.
"It's part of sort of a dynamic risk assessment that you would want to take into account, and it's concerning because as much as it plays into his PTSD [symptoms], the issues are co-related [and] it's difficult to disentangle one from the other."
Had he been Desmond's psychiatrist, Theriault said he would have sought Desmond's permission to speak with his wife.
One of the key issues the inquiry is investigating is whether Shanna, Aaliyah and Brenda Desmond had access to appropriate domestic violence intervention — and whether the health-care professionals who saw Lionel Desmond had enough training to identify the risks to his family and himself.
None of the people who interacted with Desmond after his diagnosis testified they felt he was an imminent risk of harming anyone, including clinicians who saw him at the emergency room the day before the fatal shootings.
Theriault acknowledged that Desmond's case is an extraordinarily complex one; the gaps in his treatment were compounded by the fact that he moved between provinces after leaving the military, that he lived in a rural community, that his relationship seemed unstable, and he felt isolated from friends and family upon returning to Guysborough, N.S., in 2015 after living in New Brunswick for most of the previous eight years.
"In contrast, for example, somebody who might have PTSD but otherwise has good social supports, their life is relatively stable … they don't have to worry about their income or their livelihood or their partner — but none of that is true in this case," he said.
"It makes for a much more complicated picture in trying to determine why Mr. Desmond responded to stresses in the way that he did in what ultimately happened."
Theriault is expected to continue his testimony Tuesday.
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