Canada needs national data on how veterans respond to PTSD treatment, fatality inquiry hears

The inquiry into the triple murder-suicide of veteran Lionel Desmond heard Thursday about the need to gather countrywide data to see whether the treatment veterans are getting for post-traumatic stress disorder has been successful. 

Dr. Abraham Rudnick, a psychiatrist heading a Veterans Affairs clinic in Nova Scotia, testified as an expert witness at the inquiry looking into the circumstances surrounding Jan. 3, 2017, when the Afghanistan veteran fatally shot his wife, Shanna, his daughter, Aaliyah, 10, and his mother Brenda. He then shot himself in the head.

Desmond had been struggling with symptoms of PTSD for about a decade, following a seven-month tour of Afghanistan in 2007. He wouldn't seek treatment until 2011, when he was stationed at Canadian Forces Base Gagetown in New Brunswick. 

Rudnick, the clinical director at the Nova Scotia Operational Stress Injury (OSI) Clinic, told the inquiry underway in Port Hawkesbury, N.S., that soldiers who get early intervention after a traumatic event are less likely to develop chronic symptoms connected to it. 

Of soldiers who develop acute stress disorder (ASD) — immediate symptoms, like numbness and flashbacks, after a traumatic event — about 50 per cent will go on to develop PTSD, Rudnick testified. 

"Early intervention, like in all medical health-care these days, is crucial to try to reduce that conversion from ASD to PTSD — to prevent the development of a more persistent disorder like PTSD."

The CBC's Laura Fraser was liveblogging the inquiry Friday:

Recommendations to prevent future deaths

The inquiry will provide recommendations to try to prevent future deaths like those of the Desmond family.

Rudnick also suggested to inquiry Judge Warren Zimmer the importance of gathering national research in order to plan how to best treat the veteran population as a whole. 

"We need better statistics … to better know how well we are doing, not just locally and provincially, but nationally across OSI clinics and community providers," he said. "We need statistics for that to know what works, what doesn't work, at all those levels of the journey of a soldier and then a veteran."

Rudnick said that while many veterans with PTSD and other forms of mental illness get their treatment through the OSI clinics across Canada, funded by Veterans Affairs, there are some who are treated in the community. 

The data needs to include all of those providers, he said.

"We need a data set that's national so that we can improve services."

Desmond never attended the OSI Clinic in Dartmouth, although he was referred to it by the OSI Clinic in Fredericton where he'd been treated after being discharged from the military in 2015.

Instead, after Desmond was discharged from an in-patient psychiatric facility in Montreal in 2016 — and moved back to be with his family in Guysborough County, N.S. — he appears to have opted to get treatment in the community, according to a note on his file at the OSI Clinic in Dartmouth that was entered as evidence. 

Pandemic normalized virtual psychiatric care

His Veterans Affairs case manager is alleged to have told the clinic that Desmond wanted to get counselling therapy in the Guysborough area, citing the three-hour drive to the OSI Clinic as a barrier. 

At the time, telehealth was an option. It's unclear whether that was offered to Desmond. Unlike the video conferencing era ushered in by the pandemic, at the time the clinic only offered that service on closed circuit televisions, so a client would still need to go to a Nova Scotia Health Authority site to meet virtually with a clinician.

Rudnick told the inquiry that has since changed. The clinic now offers virtual appointments for everything from psychiatry to a family doctor — and any client with an internet connection and a smartphone or computer can use it.

He told the inquiry that more than half of his patients have transitioned to virtual care, because of its accessibility. 

Rudnick said he predicts it will remain a cornerstone of care even after the pandemic.