Thread by @nziafati

The Desmond Fatality Inquiry resumes this morning.

Stay tuned for live updates. Story coming later @chronicleherald.

Here's a link to the live webcast: desmondinquiry.ca/webcast.html

Testifying this morning is Julie Beauchesne, clinical coordinator of Ste. Anne's in Montreal, where Lionel Desmond spent several weeks in a residential treatment program.

Beauchesne says there are aspects unique to military veterans dealing with mental health struggles who are transitioning from military to civilian life.

"There are specific skills and knowledge that should be considered," she says about treating such patients at Ste. Anne's.

When asked how important it is for military veterans dealing with mental health issues to receive continuity of care, Beauchesne says "it's essential."

Beauchesne saw Desmond in individual and group settings when he was at Ste. Anne's from May 30, 2016 to Aug. 15, 2016.

The different settings give patients a "variety of therapeutic opportunities," she says.

Beauchesne says she remembers Desmond was "polite," "well-mannered" and "he interacted well with people." She adds he seemed motivated to "get back on track" in his life as a father and a husband.

But, Beauchesne says she also noticed the veteran was struggling with various challenges in relation to being released from the Canadian Armed Forces (anger, frustration, etc).

Beauchesne says Desmond needed support to regulate his emotions and "make more sense of all the elements in a situation."

She notes that Desmond left sessions at Ste. Anne's with a "positive outcome," adding they helped him, made him more aware and helped him to calm down.

According to Beauchesne, Desmond would've benefitted from anxiety management strategies, coping skills, mindfulness and other strategies after he checked out of Ste. Anne's on Aug. 15, 2016.

Beauchesne says Desmond was dealing with "anxiety all the time" when he was at Ste. Anne's. He also was angry a lot of the time.

Beauchesne says leaving Ste. Anne's was difficult for Desmond, as he was planning to go back to live with his life and daughter, "knowing that their relationship was strained" and that there was "some fragility there."

She says the health-care professionals at Ste. Anne's were "concerned" about Desmond moving back to Nova Scotia to live with his family because of the possible "threat" to his continuity of care, but that he seemed to be on top of things.

"We knew it was going to be challenging, but again, everybody involved was informed of that. The main people of concern were Desmond and his wife," Beauchesne adds.

Beauchesne says they were concerned whether or not Desmond would be able to "benefit optimally from continuity of care" after being discharged from Ste. Anne's.

Beauchesne, who has an occupational therapy background, says the structure that Desmond had at Ste. Anne's was meant to give him a foundation on which he could've built a similiar structure/routine after leaving the Montreal hospital.

Beauchesne says she recommended a functional assessment be done on Desmond in her discharge summary, to help get him the treatment he needed.

But Shane Russell, the co-counsel appointed to conduct the inquiry, says that a functional assessment was never done on the veteran.

The functional assessment, in addition to a neurocognitive assessment, would've helped them understand what sort of care Desmond required when he returned home to his rural Nova Scotia community, according to Beauchesne.

Beauchesne recommended further assessment to be done on Desmond's "functional capacity and limitations" in her discharge summary.

This would've helped to identify the veteran's functional barriers at home, in his community, etc., she says.

Beauchesne says there was a cognitive screening test done on Desmond and that the results "were indicative of mild cognitive impairments, mild cognitive dysfunctions," but more assessment needed to be done.

Beauchesne says it had to be clarified what Desmond's mild cognitive impairment was stemming from, adding symptoms of depression and anxiety can also translate into cognitive difficulties/mood swings/impact judgment, "so it’s hard to really define what was reponsible for what."

If Desmond's cognitive impariments were stemming from his head injuries or concussive symptoms, for example, Beauchesne says "interventions would be tailored accordingly to the source."

Beauchesne says the team at Ste. Anne's noted that Desmond was reporting difficulties with memory, but she doesn't remember it being a major problem to the point where he would've forgotten to come to appointments, etc.

Russell asks whether Desmond had further struggles as a father, spouse, employee and friend and if these were still areas that needed to be worked on.

Beauchesne: "Yes, the work was just beginning in a way ... That's why collaborative work with other professionals was ideal."

In a phone call leading up to Desmond's discharge from Ste. Anne's, Beauchesne recalls there were tensions between Desmond and his wife Shanna "and insecurity in the part of Mr. Desmond … and anticipation around things that would unfold."

Beauchesne says she recalls Desmond needed reassurances from his wife that she wasn't going to abandon him. He also didn’t want to hear their relationship would only work based on specific conditions.

As Desmond was gearing up to leave Ste. Anne's, Beauchesne says "there were challenges there, but also some support there (from his family)."

Beauchesne says it's hard to tell if having a psychotherapist for Desmond when he returned home to his rural N.S. community instead of an occupational therapist would've been better, but he could've benefitted from having someone there to help with his transition back home.

This person, she says, could've been his Veterans Affairs case manager, an occupational therapist, a social worker, etc.

Beauchesne says the team at Ste. Anne's only tries to prevent a client from returning home if "there's concerns of immediate risk," but in the case of Desmond, there were no such concerns.

Beauchesne says she wasn't trying to suggest that a neurocognitive/functional assessment on Desmond would've prevented him from carrying out the Jan. 3, 2017 triple-murder suicide.

Beauchesne says that Desmond's discharge report would've been given to the referring team at the occupational stress injury clinic in New Brunswick who also treated the veteran, to Veterans Affairs Canada and to Desmond.

Lawyer Tara Miller says there's been no indication that Desmond got a copy of this discharge report from Ste. Anne's.

As Desmond was returning to a community without access to the treatment/health-care professionals that he required, Beauchesne confirms that Ste. Anne’s was relying on the veteran's Veterans Affairs Canada case manager and referral team in N.B. to get him follow-up treatment.

Beauchesne adds that the team at Ste. Anne's would've expressed any concerns and as much detail as possible to the VAC case manager and referral team in N.B. to help Desmond get the continuity of care he required.

Beauchesne says she doesn't recall a recommendation that was made for Desmond and his wife Shanna to have a couple's therapist in a phone call the Ste. Anne's team had with Shanna on Aug. 12, 2016.

When asked if couples therapy would have been a valuable tool for Desmond and his wife Shanna when he left Ste. Anne's in August 2016 and returned home to live with his family in N.S., Beauchesne says yes.

Adam Rodgers, the lawyer representing Desmond's estate, asks Beauchesne how many Afghan War veterans she's treated at Ste. Anne's. She says she really doesn't know.

Beauchesne says a lot of the patients at Ste. Anne's have difficulties establishing structure in their lives or a routine that gives them balance or satisfaction.

She says soldiers transitioning out of the military can face a lot of challenges such as loss and grief.

Judge Warren Zimmer asks what role a clinical care manager plays.

Beauchesne says that's a role established by VAC and that person would have specific knowledge pertaining to veterans, military culture competency and approach things with a trauma-informed lens.

Beauchesne says she thinks it's essential that a clinical care manager and VAC case manager collaborate with one another and a veteran's treatment team.

Zimmer reads a report from Desmond's visit to the ER at St. Martha's Regional Hospital on Oct. 24, 2016 that stated Desmond's symptoms had worsened.

He asks if Beauchesne would observe this as a degradation of his mental health.

Beauchesne says, "it seems so, yes."

The report states that Shanna took Desmond to the hospital on this visit, which Beauchesne says shows "there was an indication of him in there still having some hope that things can get better" and an indication that his wife was still there to support him.

Judge Zimmer reads a report from Dr. Ian Slayter who decided to taken on Desmond "outside of his normal role" and noted that Desmond had "fallen through the cracks."

Beauchesne says she cannot rule out if Desmond turned down any services that were available to him.

The judge also notes that Desmond made another St. Martha's ER visit on Jan. 1, 2017.

He spent the night there and was discharged on Jan. 2, 2017, a day before he killed his wife, daughter, mother & himself, which could suggest "further degradation of his mental health."

Beauchesne says "it's a fair observation," but doesn't know what happened on that Jan. 1, 2017 hospital visit.

She says perhaps he lost a "sense of hope" between the Oct. 24, 2016 visit and the Jan. 1, 2017 visit.

And the inquiry is on break for lunch now. More coming in the next half hour or so.

We're back.

Testifying now is Maria Riccardi, a registered art therapist, career counselor and licensed psychotherapist. She's been affiliated with Ste. Anne's since 2013.

When asked if there are any unique challenges dealing with members of military or veterans as an art therapist, Riccardi says yes. They sometimes stress and worry, she says, so you have to try to make them feel secure in an arts studio.

Riccardi says Desmond seemed to enjoy art therapy.

"It gave him something to do, something to talk with others and a place where he could play because I think Mr. Desmond … used to play a lot before the mission ... I think the goal for me with him was, let’s try to play."

Riccardi says art therapy tries to restructure how someone sees themself/help them define who they are.

Riccardi says art therapy sessions at Ste. Anne's reminded Desmond that he loved to play with children, something he seemed to hope to carry on with his daughter Aaliyah.

When Desmond made art, he seemed relaxed, according to Riccardi.

She says he didn't miss a single week of art therapy at Ste. Anne's.

In those art therapy sessions, Riccardi says Desmond shared memories of going horseback riding with his daughter, his memories with his wife, but when it came to himself, he would freeze up and didn't have a great sense of self.

In a June 20, 2016 art therapy session report, Riccardi noted that when Desmond was working on a wood-burning art project involving his daughter, he "portrayed symptoms of impulsivity and reported he has intrusive thoughts."

Riccardi says she reckoned Desmond was mourning the fact that he missed out on a lot of his daughter's upbringing while he was off on his military mission.

Riccardi recalls that Desmond used to laugh a lot, perhaps as a defence mechanism. But, she says he seemed fairly calm when he was making art.

In a June 27, 2016 art therapy session report, Riccardi wrote that Desmond reported that he would "like to reinforce a sense of safety at the centre and in his home environment. He disclosed to the art therapist that he felt tense and worried."

Riccardi says she thinks this stemmed from anxiety and that Desmond had a fear that something bad would happen.

She also recalls Desmond wanting to show this wood-burning art project (which represented an image of his daughter) to his wife.

Riccardi says this showed that the veteran wanted to form a solid relationship with his family.

Riccardi says Desmond seemed to enjoy woodmaking and taking on big art projects. When he was making art at Ste. Anne's, he was calm, but the thought of going home presented an unsettling feeling for him, she adds.

Riccardi says burning wood in the Ste. Anne's art studio made Desmond feel self-control and that he wanted to be in the present moment, but they "had to create the space for him to be there."

Riccardi says Desmond seemed concerned about his future/life after leaving Ste. Anne's.

"If I was in his shoes, I would worry too, because things would change when he went back," she says.

Riccardi notes Desmond was a perfectionist when it came to making art.

"And when you’re in the army, you have to be a perfectionist. You will die if you’re not," she adds.

Riccardi says Desmond had an "all or nothing" outlook that came out when he was making art, which was "not helpful in his life."

In a progress note, Riccardi wrote that she "strongly recommended" that Desmond carried on with art therapy post-Ste. Anne's.

She says this was the first time she strongly recommended art therapy for a veteran and it's all because Desmond came to every art therapy session and she believes it would've helped him come to terms with his trauma, "make a sense of it" and feel less weight in his life.

Riccardi says she believes art therapy really helped Desmond and that he also said it did. She felt that it took the pressure off from having to explain himself through words.

Riccardi says she's heard from veterans in the past that they'd dealt with scars for so many years, but with art therapy, they could "paint flowers again."

Rodgers asks Riccardi what she makes of Desmond creating a portrait of a superhero.

She says that superheroes are often viewed as having powers, being "invincible" and can "save the right people and come from a superior story as well," things that veterans can appreciate.

Riccardi is done testifying. The inquiry is going on another break until the final testimony of the day.

And we're back again.

The final witness testifying for the day: Julie Blondin. She's been a nurse for 28 years and has spent 17 of those years as a mental health nurse at Ste. Anne's.

She says the clients she treats at Ste. Anne's tend to have one or more traumas.

Blondin is an intake nurse at Ste. Anne's. She did Desmond's intake and was his primary nurse at the Montreal hospital.

Blondin confirms she completed the intake assessment of Desmond on May 31, 2016.

In her medical status exam of Desmond, Blondin checked a box that said the veteran was avoiding talking about his emotions.

Blondin says Desmond would exhibit "tangential speech" and that his "train of thought wandered."

Russell asks if this was a recurring theme that she observed in Desmond at Ste. Anne's. Blondin says it was.

Blondin says Desmond's mood would fluctuate from sad to disappointed to sometimes angry or happy or exuberant.

Blondin recalls Desmond ruminating a lot at Ste. Anne's. She says he would "talk and talk" about wanting his wife to come visit him one week and then a few hours later he was "happy and talking with his friends."

The nurse says she often observed an extreme shift in Desmond's mood.

Blondin notes Desmond was "quite anxious" about trying to sell his house and his finances. She says he would talk about his financial concerns "a lot repetitiously" and then he would go out with peers and his mood would seem to be OK.

At the beginning of his time at Ste. Anne's, Blondin says Desmond seemed to want to to be more involved with his family, wanted to be a better parent and to improve his relationship with his wife.

Over time though, his relationship with his wife would trigger anger.

Blondin says Desmond wasn't bothered/irritated by his wife Shanna daily, but it was a "weekly" occurrence. And when Shanna would come to visit him, she says Desmond's mood would shift to happy and calm.

Blondin says she remembers Desmond getting along well with other clients at Ste. Anne's, but doesn't recall writing down that he was "intimidating" when it came to one particular client.

Blondin wrote in her notes that Desmond was "hostile" with his wife.

She says she told him to be careful about what he says and not to use harsh words with her, but testified that they were not direct threats.

Blondin says Desmond didn't bring up his daughter Aaliyah often, but "he seemed to love her very much" and was "very happy that she was in his life."

Blondin wrote in her intake notes that Desmond was "easily distracted." She also indicated that his quality of sleep was "interrupted" and that he had nightmares.

She noted two nightmares he spoke about a bit, one where he was being hunted and another where he was paranoid.

In a note from an evening nurse, Blondin says Desmond opened about his own infidelity with his wife in front of his daughter Aaliyah.

Blondin says he feared his wife was being unfaithful to him, but then he stopped worrying that was the case.

Blondin described Desmond's relationship with his wife as difficult.

Blondin says she asked Desmond in May 2016 if he had suicidal thoughts, he told her no, but took note that he made a past suicide attempt four and a half years ago and wrote down "shotgun."

In hindsight, she says she should've written down more about this attempt in her notes.

When Desmond disclosed that he had a past suicide attempt, Blondin says she didn't ask if he had access to firearms. She says she probably should've, but they don't necessarily ask their clients this question.

Blondin says Desmond's tolerance threshold to anger and frustration was quite low.

"Your patience level is low with PTSD, that's one of the symptoms," she adds. "As soon as something wasn't going his way, that's when he got frustrated and anxious and irritable."

Whenever he was asked about suicidal ideation, Blondin says Desmond didn't share suicidal thoughts.

Blondin says she noticed Desmond would often go out with his peers to the movies, shopping, fishing, etc. despite the fact that he said he had financial problems.

Blondin took note that the two things that Desmond would react to strongly were watching war action movies and arguing with his wife.

She recalls Desmond only had happy thoughts of his daughter, a stark contrast to the way he felt towards his wife.

The inquiry has wrapped up for the day.