GUYSBOROUGH, N.S. -- A nurse who assessed Lionel Desmond two months before the mentally ill veteran killed his family and himself in 2017 says his symptoms of post-traumatic stress disorder appeared to be getting worse during a period in 2016 when he wasn't receiving any treatment.

Heather Wheaton, a mental health crisis clinician, told a provincial fatality inquiry Tuesday she met Desmond on Oct. 24, 2016 when he showed up with his wife Shanna at the emergency room at St. Martha's Regional Hospital in Antigonish, N.S.

At the time, Wheaton filled out a mental health assessment form, noting the former infantryman was suffering from interrupted sleep, nightmares, loss of appetite, aggression towards objects, conflict with his wife and increasing anger, depression and anxiety.

As well, Wheaton noted that Desmond was diagnosed with PTSD in 2011, had paranoid ideas about his spouse, lacked concentration and was "not sure how to live as a civilian" since his discharge from the army in 2015 -- eight years after he served in Afghanistan.

"Very brief stability and then problems getting worse since then," she wrote in her notes on Oct. 24, 2016.

Wheaton concluded that Desmond had thoughts of suicide, but she stressed he did not seem to have a plan or any real intent. A psychiatrist later assessed Desmond's risk of suicide as "low."

Wheaton's notes indicate Desmond received treatment at the Ste. Anne's Hospital operational stress injury clinic in Montreal between June and August of 2016, but Desmond said there had been a two-month gap in follow-up treatment because of a snafu with the federal Veterans Affairs Department.

The inquiry has heard that after Desmond was discharged, he and his wife lived in New Brunswick, where a Veterans Affairs case manager supervised his ongoing care -- but there was a gap in 2016 when Desmond returned to his home in Upper Big Tracadie, N.S.

Wheaton said Desmond and his wife were waiting for a phone call from Veterans Affairs to confirm a new case worker in Nova Scotia and they were hoping the department would make arrangements for him to see a private therapist, whose fees would be covered by Ottawa.

In notes she took that day, Wheaton found Desmond was having "trouble navigating the Veterans Affairs system and worried about what they will offer and what they will cover."

Wheaton agreed when asked if it was sometimes difficult for her to access medical records from outside Nova Scotia's eastern zone or to share records with other agencies outside the provincial health authority. She also said patients were often required to get their own records before they could be shared.

Inquiry counsel Shane Russell told Wheaton: "I take from your note that a recurring theme with Lionel Desmond is this concept of trying to get care but it just seems to be not happening."

On Monday, a lawyer representing the attorney general of Canada told the inquiry that Desmond's case manager was working on finding the services he needed in Nova Scotia, but there was some dispute over where he would have to go -- Halifax or Cape Breton.

The gap in services is important because the inquiry is examining whether Desmond and his family had access to adequate mental health services.

The inquiry, which started hearings Jan. 27, is also investigating whether the Desmond family had access to domestic violence intervention services and whether health-care providers who interacted with the former corporal were trained to recognize occupational stress injuries or domestic violence.

Wheaton, a nurse with more than 20 years of experience, told the inquiry she did not receive any formal training regarding domestic violence.

When Russell asked if that kind of training would be useful, Wheaton said she felt capable of making a proper evaluation by using a mental health assessment form.

"I believe that we evaluate the risk," she testified. "(But any) information about domestic violence, specifically, I wouldn't say no to. Any information that helps us to be more sensitive or more aware is welcome."

The provincial court judge overseeing the inquiry, Warren Zimmer, asked Wheaton if the assessment tool had specific indicators regarding domestic violence or homicidal inclinations.

Wheaton replied:"If there's a cue of any kind -- if somebody has anger, for example -- we would explore that fairly extensively with the person and ask for examples.

"(It's) with an awareness that if a person is going to act out violently towards another person, more often than not that's going to occur in their intimate relationships."

On Jan. 3, 2017, Desmond fatally shot his 31-year-old wife, their 10-year-daughter Aaliyah and his 52-year-old mother Brenda before turning the gun on himself in the family's rural home.

The day before, Desmond was released from St. Martha's Hospital by a psychiatrist who determined the 33-year-old former soldier was not a threat to himself or anyone else.

This report by The Canadian Press was first published Feb. 11, 2020.

-- By Michael MacDonald in Halifax.