A Nova Scotia family is frustrated with a lack of answers about whether a former Canadian soldier got proper help for severe mental-health problems in the months before he fatally shot three members of his family and himself.

Afghanistan war veteran Lionel Desmond, 33, killed his 52-year-old mother Brenda, his wife Shanna, 31, and their 10-year-old daughter Aaliyah, in the family's Upper Big Tracadie, N.S., home on Jan. 3.

Desmond's family has provided CBC News with documents that offer a glimpse into the year leading up to the deaths.

Still, many of the family's questions remain unanswered.

According to a medical assessment obtained by CBC News, a Fredericton family doctor determined Desmond was "non-suicidal and stable" and that he had "no concerns for firearms usage" in February 2016, three months after Desmond's wife called RCMP to report her husband was threatening to harm himself with a gun.

It's not clear from the documents the status of any gun licence Desmond might have had at the time, but the assessment was done for New Brunswick's Chief Firearms Office.

Firearms officers in each province have the power under federal legislation to revoke a person's firearms licence if they believe the person could harm him or herself or others, based on evidence from medical professionals, police and others.

What changed in those final months

Dr. Paul Smith said Lionel Desmond was stable and doing 'extremely well' a year before his death. (Karissa Donkin/CBC)

Dr. Paul Smith, the doctor who signed off on the form, told CBC News that Desmond was stable and doing "extremely well" at the time. He had suicidal thoughts in the past, he said, but improved after he began using medical marijuana.

Desmond had served in the war in Afghanistan in 2007 and suffered from post-traumatic stress disorder.

The doctor lost contact with Desmond in the spring of 2016, after the former soldier sought treatment in Ontario and then moved to Nova Scotia.

Smith is struggling to piece together what changed in Desmond's life in those final months.

"We were shocked and saddened, like everybody," Smith said in an interview with CBC News.

"My initial thoughts were, 'He was doing so well. What happened?'"

Desmond threatened to self-harm

On Nov. 27, 2015, RCMP in New Brunswick received a call from Shanna Desmond stating that her husband had sent her text messages saying he was on his way to the garage and was going to use a firearm to harm himself, according to the medical assessment signed by Smith.

He told her to say goodbye to their daughter and that he would see her in heaven. - Desmond's medical assessment

At the time, he was living in New Brunswick while his wife and daughter were living in Nova Scotia.

"He is a military veteran and has PTSD. He told her to say goodbye to their daughter and that he would see her in heaven," the assessment said.

"Police attended the residence; our client met with them and said he did not have any intention of hurting himself, but that he was very depressed. He is concerned for his wellbeing. He was driven to the hospital, where he was seen by a doctor."

RCMP in New Brunswick declined a CBC News request for comment on the incident.

No concerns that Desmond posed risk

On the medical assessment form, Smith checked off that he had no concerns that Lionel Desmond posed a safety risk to himself or others.

The form was also signed by Joe Roper, an area firearms officer with New Brunswick's Department of Public Safety, on Jan. 20, 2016.

A collage of Lionel Desmond, his wife Shanna, mother Brenda and daughter Aaliyah and his military comrades. (CBC)

Lionel Desmond's sister, Cassandra Desmond, doesn't understand why her brother was permitted a firearms licence.

"What type of physician is still going to sign off and allow a man to have his gun licence if he states that he's concerned for his wellbeing and he was threatening his own life? But you're still going to deem him responsible enough to hold a firearm?" Cassandra Desmond asked in an interview.

New Brunswick's Department of Public Safety declined to comment on the specifics of Lionel Desmond's case, but described it as a "tragic situation."

In an emailed statement, spokesman Paul Bradley said the assessments are taken "very seriously" in accordance with the federal Firearms Act.

"Provincial officials make the determination based on the assessment of the medical professional and the data provided," Bradley wrote.

'He was very stable'

Smith said his assessment would have been one of several pieces of evidence that would have been used to decide whether Lionel Desmond should have firearms.

"My involvement simply was an opinion given at the time that I had known him," Smith said.

"He was very stable."

In the past, Smith said he has told firearms officers that a person with PTSD shouldn't be allowed to have a firearms licence. Other times, he's suggested the person isn't ready and to check back in a few months.

But Smith didn't have those concerns with Lionel Desmond.

Cassandra Desmond speaks about her family's frustration trying to find answers about the help her brother received before he killed three family members and took his own life in January. (CBC)

The RCMP's firearms licence renewal form asks if the person applying has threatened or attempted suicide in the past five years or suffered from or been diagnosed or treated by a medical practitioner for depression, behavioural or emotional problems or alcohol, drug or substance abuse.

Typically, mental-health concerns are reported by a person's family, law enforcement or a concerned member of the public, according to the RCMP.

But Smith doesn't believe every soldier who's had mental-health issues should be barred from owning firearms.

"Every PTSD soldier has suicidal thoughts. Everybody," Smith said.

"That's part of the definition of [PTSD]. When we first met him, he certainly admitted to having suicidal thoughts in the past, as they all do. With his therapies, it virtually disappeared."

Yoga and gym recommended for PTSD

Lionel Desmond was on prescription drugs prior to being prescribed medical marijuana to treat his PTSD, but his sister does not know what other treatment her brother received before the shootings.

'My initial thoughts were, 'He was doing so well. What Happened?'' - Dr. Paul Smith

A second document shows that just four weeks before the killings, a psychiatrist at St. Martha's Regional Hospital in Antigonish, N.S., recommended Desmond go the gym and do yoga to cope with his severe post-traumatic stress disorder.

"Mr. Desmond has severe problems with PTSD and post-concussion disorder. He would benefit from regular participation in a gym and in yoga but needs financial assistance to afford them," Dr. Ian Slayter, of the hospital's department of psychiatry, wrote in a letter dated Dec. 2, 2016.

"That right there ... just disgusts me," Cassandra Desmond said. "This is how they feel that they should help our veterans."

The family claims that Lionel Desmond was turned away from St. Martha's Regional Hospital in Antigonish one day before the shooting. A doctor at the hospital has previously denied that allegation and said that it has never turned anyone away.

Lionel Desmond was part of India Company, 2nd Battalion, Royal Canadian Regiment in Afghanistan in 2007. (Facebook/The Canadian Press)

However, Slayter's letter alone leaves Cassandra wondering what other information the Nova Scotia Health Authority "is hiding" that may show her brother was not receiving the help he needed.

Smith also questions whether Lionel Desmond was allowed to continue using medical marijuana during his treatment in Nova Scotia, saying the province is "lagging behind" in accepting it as a valid treatment.

Family waiting for answers

Months after the tragedy, Desmond's family is waiting for answers about what care the former soldier received. They are still trying to set up a meeting with the health authority and say they are frustrated by the lack of response.

It's not easy ... seeing the people you love suffer in silence. - Cassandra Desmond

Slayter was not available for an interview. However, Kristen Lipscombe, a spokesperson for the Nova Scotia Health Authority, said in a statement that the authority has an obligation to protect personal health information under provincial legislation.

The authority cannot answer questions or release details about individuals. And that includes sharing or confirming information related to a person's care or treatment, she said.

Authority says it will meet with family

The health authority completed a quality review into Desmond's dealings with the Nova Scotia health-care system in March. But that report will not be released to the public.

Colin Stevenson, vice-president of quality system performance and transformation with the Nova Scotia Health Authority, confirmed on Friday they are trying to set up a meeting with Desmond's family.

"My understanding, based on conversations to date, is what they would like to be hearing from us includes the results of and the recommendations associated with that quality review and we are prepared to discuss that with the family," Stevenson said in an interview.

Stevenson said the quality review will not be made public because the process is confidential so staff are protected and can be open about any flaws in the system.

"And as a general rule we don't speak to reviews within specific cases," he said. "And good practice within health care across the country is to create an environment where people are willing to disclose incidents and that really is what we're trying to encourage."

Stevenson would not say how many recommendations came out of the review or the nature of those recommendations.

"We'd be having a conversation with the family before any information is shared beyond that," he said.

If asked, the health authority would fully co-operate with a public inquiry, Stevenson said.

Night terrors, cold sweats, fear of water

Cassandra Desmond said her brother had night terrors, cold sweats and was afraid of water for a while after he returned from the war.

"He couldn't be around family too long. I'm not saying he couldn't be around us period," she said.

"He was raised in a large family and a loud family and … just loud noises, and stuff like that, anything loud or even sudden whispers, would remind him of, say, for an example, trees [rustling]."

Lionel Desmond went from a carefree, down-to-earth, free-spirited person — the family comedian — to "fight or flight" and just constantly feeling that he was mentally under attack by things, his sister recalled.

"And, there were days, you know, where he could still be that happy-go-lucky guy, but then anything could have triggered off to … things that relayed back to whatever it is that he discovered and seen and went through over on the grounds of Afghanistan," Cassandra Desmond said. "It's not easy … seeing the people you love suffer in silence."

Lionel Desmond and his mother Brenda Desmond were two of four family members that died in a murder-suicide in Upper Big Tracadie, N.S., in January. (CBC)

In New Brunswick, Smith thinks about his former patient every day.

So do many of the clients in his office who are struggling with PTSD and coming to terms with the decisions Lionel Desmond made.

"I would love to have known what was going through his head in that last few months or weeks or days or whatever it was that he came to that kind of conclusion," Smith said.

"I wish that more people had been there for him and he didn't feel alone like he did. He must have felt extremely distraught and alone in the world in order to make that kind of decision."

No decision on fatality inquiry

Last week, Dr. Matthew Bowes, Nova Scotia's chief medical examiner, said he'll consider ordering a public inquiry into Desmond's death under the province's Fatality Inquiries Act, if a provincial review of Desmond's mental-health treatment isn't adequate. Bowes also said he will consider family members' views on the issue.

Bowes also was not available for an interview. However, his office issued a statement through the Justice Department.

"Dr. Bowes does not have a set timeline on his decision," the statement said. "The Nova Scotia Health Authority quality review and response need to be determined before a decision is made."

I wish that more people had been there for him and he didn't feel alone like he did. - Dr. Paul Smith

When asked about the process that happens if police believe that a person with firearms could be a danger, Staff Sgt. James Bates, spokesman for New Brunswick RCMP, said he could not discuss anything related to a specific case.

"There are obviously provisions in the Criminal Code that as police officers, we would use to deal with a particular case, given the circumstances," he said.

When it comes to someone's access to firearms or ability to possess them, public safety has provincial jurisdiction and the national firearms program has federal jurisdiction, Bates said.

"Depending on the imminent nature of the situation, we would deal with it," he said.

The final decision, however, on whether somebody is fit to continue having a licence is a collaborative one between RCMP, public safety and the Canadian Firearms Program.