Desmond inquiry: Lionel Desmond's case manager testifies about bureaucratic barriers
Published Tuesday, June 22, 2021 12:21PM ADT Last Updated Wednesday, June 23, 2021 6:29AM ADT
Shanna and Lionel Desmond hold their daughter Aaliyah in a photo from the Facebook page of Shanna Desmond. (HO-Facebook/The Canadian Press)
PORT HAWKESBURY, N.S. -- In the four months before former soldier Lionel Desmond killed his family and himself in 2017, his case manager with Veterans Affairs was frustrated by bureaucratic barriers that delayed his rehabilitation, a public inquiry heard Tuesday.
Marie-Paule Doucette told a provincial fatality inquiry that the Afghanistan war veteran was admitted to a rehabilitation program in May 2015 because he was suffering from severe post-traumatic stress disorder. She said she didn't start working with him until November of that year -- a six-month delay she blamed on a backlog caused by government cutbacks.
As a case manager, Doucette's role was helping veterans overcome barriers to reintegrating into civilian life, which included providing guidance on obtaining treatment and dealing with other challenges.
Doucette said the goal of Veterans Affairs was to have each case manager handle a maximum of 25 veterans, but her caseload had grown to between 35 and 40 by January 2017.
The inquiry has heard Desmond, who served as an infantryman in Afghanistan in 2007, was diagnosed with PTSD in 2011 and medically released from the military in June or July of 2015. At that time, he was referred to the Operational Stress Injury Clinic in Fredericton, which is not far from Canadian Forces Base Gagetown where he was posted.
Doucette confirmed Desmond was receiving psychiatric treatment and therapy at the clinic, but his sessions were often interrupted by frequent visits to his hometown in eastern Nova Scotia. At the time, Desmond and his wife, Shanna, and their young daughter, Aaliyah, were in the process of moving back to Nova Scotia.
By November 2015, the clinic had concerns about Desmond's mental stability, Doucette testified, adding that she first met her new client the following month when she conducted a detailed assessment.
Referring to the assessment file, Doucette said it was clear Desmond was struggling with mental health issues, though there were no signs he was contemplating suicide or self-harm. At the time, Desmond was friendly and trusting when the two met in his tidy home in Oromocto, N.B., she said.
"He seemed to be happy to be engaging," she said. "I didn't get a sense that he was mistrusting me."
The file also said Desmond had difficulty controlling his emotions and suffered from panic attacks, angry outbursts and relatively constant marital strife.
Desmond also told her the police had been recently dispatched to his home because his wife was worried he was about to kill himself, Doucette said. But Desmond insisted his wife had misunderstood what he was saying, she added.
The inquiry has heard that police in Fredericton seized a firearm from his property during that call.
As well, Desmond told Doucette he was having difficulties dealing with his PTSD symptoms and persistent marital and financial problems.
"He felt he needed more support from professionals," Doucette said.
The plan for Desmond, arranged by the clinic in Fredericton, was to have him attend an intensive residential treatment program at Ste. Anne's Hospital in Montreal, where the goal was to stabilize his mental health before treating his trauma with therapy.
Desmond attended the program between June and August of 2016, but the staff there determined he had made little progress. More importantly, they said he needed more treatment and a comprehensive neuropsychological assessment to test for possible cognitive impairments that may have been interfering with his treatment.
But that never happened.
The inquiry has heard that Desmond received no therapeutic help for the next four months, despite Doucette's efforts to help him get the help he needed in Nova Scotia.
That gap has become a focus of the inquiry, which started hearings in January 2020 but has twice been delayed because of the COVID-19 pandemic.
Doucette said it was agreed that after Desmond left the hospital in Montreal, she would continue to oversee his case, even though his move from New Brunswick to Nova Scotia would normally require a transfer to another case manager. Referring to her notes, Doucette told the inquiry she remained in close contact with Desmond between August and December of 2016.
But there were delays that made it difficult for Doucette to do her work. Her attempts to arrange for the help of a so-called clinical case manager, for example, were frustrated by training delays and bureaucracy.
In notes she prepared after the tragedy, Doucette said: "Significant bureaucratic barriers complicated the process to have (clinical care manger) services started. (Case manager) would like to discuss with decision-makers at some point, if at all possible."
As case manager, Doucette also had to deal with the fact that Desmond wanted to receive services near his rural home in Guysborough County rather than Halifax, which complicated the search for assistance.
"There were a lot of moving parts," Doucette told the inquiry. "I wanted to stay connected until he had some stable supports in place."
Doucette eventually sought the help of Catherine Chambers, a private psychotherapist based in Antigonish, N.S., who specialized in treating veterans and first responders with PTSD.
But there were more delays because Desmond failed to follow up on instructions to contact Chambers for several weeks.
The inquiry has heard that Chambers was in the process of assessing Desmond for treatment when, on Jan. 3, 2017, he bought a rifle and killed his wife, mother and 10-year-old daughter in their home in Upper Big Tracadie, N.S.
"I'm not sure there's much more I could have done in terms of preventing this," Doucette said.
"I obviously did not have all of the information regarding what was happening in the marital relationship. I definitely have no hesitation now in asking more direct questions if someone is reporting conflict in their marital relationship."
This report by The Canadian Press was first published June 22, 2021.