An Australian special operations soldier told a psychiatrist months before he took his own life that he could not live with himself because he had killed so many people, an inquest has heard.
"I've killed so many people, I cannot live with myself, I have killed innocents," was one of the first sentences out of Sergeant Ian Turner's mouth in his first session with Dr Muhammad Malik when he was admitted as an inpatient at the St John of God private hospital in April 2017, Dr Malik told a NSW coronial court on Tuesday.
"I remember when I started engaging him, I think the second, third, fourth sentence was this," Dr Malik said.
The comment showed him that Sgt Turner was "guilt-ridden" and had a sense of morality, he added. Sgt Turner did not say anything more about the incidents.
He was one of the worst post-traumatic stress disorder cases Dr Malik had ever seen, he said.
Sgt Turner had enlisted in 2000 and deployed seven times to Afghanistan, Iraq and East Timor, deploying on combat operations for nearly three years.
He spent four weeks at St John of God Hospital, and had earlier received inpatient psychiatric treatment in 2014.
His final deployment to Iraq in 2016 was only made possible after a major intervened to have a refusal of medical clearance reconsidered, the court heard on Monday.
During that deployment, he was demoted after playing a prank with a pornographic card. He became demotivated after being made to change company.
Dr Malik said he formed the view during their first session that Sgt Turner would not be able to return to the military.
He was self-medicating with drugs and alcohol, and suffering from flashback, nightmares and lack of sleep.
"Even if he was discharged from the military he would have struggled," Dr Malik said, adding that there is no cure for PTSD.
Sgt Turner's wife, Joanna Turner, gave evidence that her husband boasted of being able to mislead mental health professionals.
Dr Malik said he had to trust his patient and challenging him too much on his self-reporting would prevent Sgt Turner from engaging in treatment after he was discharged from hospital.
Ms Turner told the inquest she did not receive enough support from the Australian Defence Force after informing them that she was experiencing domestic violence and her husband was drinking excessively.
He was increasingly violent and controlling towards her from about 2009, with his behaviour changing after deployments, Ms Turner said.
She said that she raised her concerns about his conduct and mental health with a brigadier, army chaplains and a welfare officer in 2014.
The welfare officer with the Australian Special Forces' Second Commando Regiment stayed in contact with Ms Turner throughout 2014 and provided "appropriate" support, she said.
However, Ms Turner said she believed the army did not make enough effort to look outside his service for information about his welfare, and wished his unit had been provided with more information about his family circumstances.
By about 2016, Ms Turner said she had stopped raising his conduct with the army. "I had lost hope," she said.
After 2013, he occasionally told her that he hoped to die on deployment overseas, she said.
Ms Turner, a practising psychologist, said she felt that he needed mental health treatment that was more personalised, but agreed the treatment he was given was adequate.
The couple had separated at the time of his death and was discussing divorce.
A fellow soldier assigned to be Sgt Turner's "battle buddy" and stay with him on the weekend of his death told Ms Turner he did not do so as he had been hospitalised due to his own issues with substance abuse, she said.
At the time of his death in July 2017, he had been talking about accepting a medical discharge from the army.
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Australian Associated Press