Sexual offences committed by members of the armed forces: Is the service justice system fit for purpose?
Abstract: Recent policy reviews, academic research and high-profile media critiques have repeatedly emphasised the UK military as a hypermasculine culture, seemingly permissive of sexual violence, marked by high prevalence of sexual offences and inadequate justice response. The service justice system has been characterised by low conviction rates and poor treatment of victim-survivors of sexual offences, prompting recommendations that rape should be tried in the civilian criminal justice system rather than the service justice system. Despite notable debate on this matter, the Ministry of Defence (MOD) ultimately rejected this recommendation in December 2021 and instead committed to implementing clear and meaningful change within the service justice system response to sexual offences. In light of this decision, this article interrogates available data about the current service justice system response to sexual offending, and lessons that may be learnt from the civilian criminal justice system, to highlight current obstacles to justice and outline areas in which further research and scrutiny is necessary.
Abstract: There are a number of treatments that have an emerging evidence base and could be considered in the management of common mental health conditions affecting veterans. Emerging and adjunct treatments are typically considered when an individual’s adherence or response to accepted or conventional treatment/s is poor (i.e., chronic, treatment-resistant, or treatment-refractory mental health conditions). The aim of the rapid evidence assessment (REA) was to identify and critically evaluate the current evidence on emerging and adjunct treatments for posttraumatic stress disorder (PTSD) and common mental health conditions affecting veterans. From the four databases that were searched, 25 studies met the inclusion criteria, including 12 secondary sources: four (4) systematic reviews (SRs) and eight (8) SRs with accompanying meta-analyses (MAs). The studies within these secondary sources (i.e., those contained within SRs and MAs) were extracted to a database containing the primary sources (i.e., randomised controlled trials, RCTs). From this collated set of articles (281 in total), all studies that did not meet the inclusion criteria were excluded (e.g., cohort and case-control studies), and all duplicate studies were removed (i.e., often the same RCT would appear in multiple SRs and MAs; as well as being directly retrieved by the search strategy). The final set of articles included 13 RCTs. The findings from these studies were narratively synthesised, and risk of bias assessments were conducted for each RCT. Strengths of the REA include the focus on peer-reviewed Level I and Level II evidence (NHMRC, 2009) from scientific journals in the fields of health, medicine, psychiatry, and psychology (including a specialist database developed by the US Department of Veterans’ Affairs focusing on literature relevant to veterans with PTSD). Limitations of the REA include the exclusion of potentially relevant papers that were published prior to 2017 and the exclusion of non-English language papers. It is difficult to draw conclusions and recommendations regarding DCS interventions from the body of evidence considered by the REA. DCS is proposed to enhance fear extinction or extinction learning via partial agonism of the NMDA receptor (neurobiological mechanism of action). Thus, most of the included studies examined the effects of DCS administration in combination with exposure-based psychotherapy for anxiety disorders. Some studies appear to indicate that DCS improves outcomes from evidence-based psychotherapy. However, due to the mixed findings across studies, it is difficult to recommend the use of DCS interventions in specific clinical situations. Further high-quality research is required.