News features

UK minoritised ethnicity ex-Service personnel: a review of current research and highlighting gaps

Language is continuously evolving, and we recognise that there are numerous terms, words and phrases that are used when referencing ethnicity. Whilst in the United Kingdom (UK) the ‘white’ ethnicity group is the majority, this is not reflected globally and highlights how in certain contexts, individual ethnic groups may be the minority as a result of power and social processes [1]. The following feature has chosen to use the term “minoritised ethnic” or “minoritised ethnicity” to acknowledge these influences when referencing ethnicities that differ from the white majority.   

Introduction  

In their most recent Biannual Diversity Statistics release, the Ministry of Defence (MoD) shared that individuals from minoritised ethnicity backgrounds (excluding white minorities) represented 10.1% of the UK Regular Forces, with 80.8% of all minoritised ethnicity personnel (excluding white minorities) in the UK Armed Forces belonging to the Army and Army Reserve. The statistics also detail that, although not yet representative of the minoritised ethnic population in the civilian population, the number of ex-Service personnel identifying as belonging to minoritised ethnicity backgrounds in the UK Armed Forces is growing year on year. This news feature therefore provides a review of existing evidence about the experiences of minoritised ethnic ex-/Service personnel, draws attention to currently funded research projects exploring British minoritised ethnicity Serving and ex-Service personnel in the UK, and identifies current research gaps. 

Health and healthcare  

Evidence indicates that health outcomes for ex-Service personnel are impacted by ethnicity. In a study exploring the mental health diagnoses of UK ex-Service personnel, individuals who identified as ‘non-white' had higher odds of having a personality disorder (AOR = 3.10, p < 0.001) and psychosis disorder (AOR = 1.82, p = 0.001) compared to white ex-Service personnel [2]. However, the researchers do acknowledge that these results should be considered with caution given the small sample size and highlight an avenue for future research. Nevertheless, evidence from the United States (US) suggests that ethnicity impacts a broader range of mental health conditions. In the US, adverse health outcomes reported among minoritised ethnicity ex-Service personnel include increased risks of dementia [3], Post-Traumatic Stress Disorder (PTSD) [4] and diagnoses of other common mental health disorders [5]. In addition to these mental health diagnoses, some US research has highlighted that black ex-Service personnel showed less improvement in reducing symptoms of PTSD and also experienced a higher recurrence of depressive symptoms after a 4-month follow up post treatment [6].  

Although lacking evidence from a military population, UK evidence demonstrates similar patterns of ethnicity related health outcomes in civilian populations. Findings from the Adult Psychiatric Morbidity Survey (APMS) demonstrate that individuals from minoritised ethnicity backgrounds are more likely to be diagnosed with a psychotic disorder, with black women more likely to experience common mental health problems than their white counterparts. These statistics are supported by more recent research from a UK systematic review and meta-analysis revealing that minoritised ethnic groups are at an increased risk of affective and non-affective mental health disorders, including schizophrenia. The King’s Fund Report: ethnic inequalities and the NHS highlights contributing factors to health inequality in civilians including the disproportionate socioeconomic deprivation faced by minoritised ethnic groups and the damaging effects of facing structural racism on mental and physical health. Understanding whether these patterns of mental health disorders are present in Armed Forces personnel, and if so, whether military service contributes to these, should be a focus for future research.  

As mentioned, in comparison to white ex-/Service personnel, very little is known about UK minoritised ethnicity ex-/Service personnel. However, US evidence suggests that military service may also influence healthcare service utilisation for minoritised ethnicity personnel. Despite the increased rates of mental health disorders reported by minoritised ethnic ex-Service personnel, evidence highlights that Black, Hispanic and Asian Service members were less likely to receive treatment for depression and that there were reduced admission rates to inpatient services and psychotherapy treatment [7]. This discrepancy in treatment receipt may be influenced by a component of ethnicity – culture. As minoritised ethnic personnel in these studies are receiving treatment from institutions largely rooted in Western cultural practices, healthcare providers’ decisions and understanding are likely to be influenced by these [8]. As well as clinicians’ decisions to administer treatment, these differences can impact the therapeutic relationship and expectations of care. The Race and Health Observatory’s Rapid Evidence Review of Health Inequalities in Healthcare offers an insight into these barriers in the UK National Health Service (NHS). Individuals from minoritised ethnic groups reported instances of fear of institutional racism and a general distrust in care providers. Although not limited to a military population, the report reinforces the notion that sociocultural differences are intertwined with ethnicity and contribute to healthcare service access and utilisation in wider minoritised ethnic groups.     

The finding that minoritised ethnicity Service members are less likely to receive treatment is not unanimous amongst existing literature. US researchers report that military service may in fact be a facilitator of access to healthcare services, with minoritised ethnicity ex-Service personnel more likely to access treatment sooner compared to their ethnicity-matched civilian counterparts [9]. This finding is supported by earlier research Koo et al. (2015) who found comparable rates of healthcare service utilisation between ex-Service members from white and racial-ethnic minority groups and is suggestive that knowledge of and access to healthcare services through the military are facilitators of seeking appropriate health treatment. However, as US civilians, unlike US Service members and their families, do not automatically receive free access to healthcare, applying these findings to UK contexts where both civilian and military personnel have access to a free healthcare system should be done with caution and invites an additional call for research.   

Interestingly, this advantage was not replicated in Koo et al.’s study when racial-ethnic minority groups were separated by their specific racial-ethnic identities (e.g., American Indian, Hispanic, Black). An example of this is that, when analysed within these ‘subgroups’, black ex-Servicemen were less likely to be admitted to inpatient psychiatric care (despite being more likely to use mental health outpatient services) than white ex-Servicemen. Differences were also observed in emergency services use between Asian/Pacific Islander ex-Service personnel and their white ex-Service personnel counterparts, and in outpatient service utilisation between women who identified as American Indian, Hispanic, or White.   

In the UK, recent research demonstrates that minority ethnic ex-Servicemen from Commonwealth Countries have unique barriers to engaging with treatment services [10]. For non-white Commonwealth ex-Servicemen who have served in the UK Armed Forces, individuals faced barriers including discrimination and unfair treatment representative of institutional racism when seeking treatment for both their physical and mental health. These barriers did not start, or end, upon leaving the Armed Forces but rather were already apparent whilst serving.   

These findings are synonymous with figures from the UK Army Sexual Harassment Report 2021 that states that minoritised ethnic personnel were more likely than the white majority to report instances of sexual harassment and were overrepresented in complaints concerning bullying and harassment in general. Whilst there is a lack of research into how this harassment influences the lives of minoritised ethnicity ex-/Service personnel in the UK, for US Service members, the increased reporting of poor mental health for ex-Service personnel may be a consequence of racial discrimination. For example, one US study found that racial discrimination significantly moderated the effect of race on PTSD for black ex-Servicemen and women [11].   

Categorising ethnicity  

The variance in healthcare utilisation between specific minoritised ethnicity groups in Koo et al.’s US study is an important consideration for future research. This study highlights that there are differences between the experiences of the minoritised ethnic subgroups and that comparing the white majority with ‘everyone else’ is insufficient in understanding the experiences of minoritised ethnic groups.  

The problem around ‘ethnicity grouping’ is also evident for military personnel who have served in the UK. In the aforementioned study on Commonwealth ex-Servicemen by Pearson et al. (2021), individuals from St Lucia and Fiji both identified as Black Caribbean, yet these countries are over 8,000 miles apart. Excerpts from interviews with these minoritised ethnic ex-Servicemen from Commonwealth countries highlighted that they were likely to share their problems and concerns with individuals from their own country; references of community and collective identity were made to specific countries rather than ethnic categories and highlights how broader ethnicity categories, such as Black Caribbean, that encompass geographically diverse populations, may not always provide the best understanding of the experiences of specific minority ethnic ex-Service personnel.   

From mostly US research and some emerging UK studies, evidence suggests that ethnicity-related differences exist amongst health and healthcare status for minoritised ethnic military personnel. As highlighted by Pearson et al (2021), research into UK Armed Forces ex-Service personnel from minoritised ethnicity backgrounds tends to focus on non-UK individuals. Whilst beneficial in deepening the understanding of whole force experiences, British ex-/Service personnel from minoritised ethnicities appear to be a population distinctly lacking in existing research. More research is needed to explore these experiences, and should address the ethnic, cultural, and social barriers of individual sub-populations to ensure that disparities in all service access, not just healthcare, are understood and barriers can be addressed.   

Post-Service experiences and employment  

There is a growing number of studies exploring the experiences and impact of transition from military to civilian life both in the UK and globally. Whilst a successful transition is the case for most Service personnel, transition challenges and readjustment complications including, but not limited to, employment and legal difficulties, self-esteem changes, and interpersonal relation struggles can occur. However, US evidence suggests that ethnicity also plays a role in readjustment to civilian life, with stressful life events more frequent during this period amongst “minority-race” and Latinx ex-Service personnel [12]. Similar to previously mentioned research, this study also found increased and sustained symptom severity for common mental health issues for ethnic-minority Service personnel further alluding to ethnicity-related differences in transition outcomes and experiences.   

Whilst military Service and experiences influence transition for ex-Service personnel, the non-military labour market may also contribute to post-Service experiences. Although research on this is lacking for UK populations, US research has found that black ex-Service personnel deemed to have transferable skills such as administrative experience obtained from military service, received preferential treatment from employers compared to black civilians [13]. However, when considering ‘traditional military experience’, for example those who had served in combat, military status was not favourable regardless of ethnicity. In fact, black ex-Service personnel were deemed to face significant disadvantages compared to those from other ethnicities including low interview call back rates and subsequent hiring. Interestingly, this pattern was not reflected in former Service members from Hispanic backgrounds, with these individuals facing less of a disadvantage.   

Not only are UK and US employment activities different from one another, but the labour-market has also evolved drastically since the release of this paper in 2009, not least with the introduction of strategies such as the MOD’s Defence Diversity and Inclusion Strategy 2018-2030 in the UK. Although US based, recent research has described barriers to ex-Service personnel securing employment as “organisational and societal and personal” [14] making apparent the complexity of transition experiences which may be emphasised by ethnicity and social identity. With these discrepancies highlighted and the lack of UK research on ethnicity-related implications of military service on post-military experiences such as employment opportunities, it is apparent that more research is needed to understand the transition experiences of UK minoritised ethnicity Service personnel.  

Secondary focus  

Although ethnicity is seemingly lacking as the primary focus of research on UK Armed Forces personnel, there are a few UK studies that report differential outcomes as a result of ethnicity for military personnel. For example, Dighton et al. (2023) [15] explored the motivators for gambling in a sample of UK ex-Service personnel and found that non-white ex-Service personnel were at an increased risk of problem gambling. Perhaps most salient in the context of this news feature, however, is that one of the significant protective factors for ex-Service personnel against developing problematic gambling behaviours was belonging to the ‘white’ ethnic group. Although not further expanded on in the study, this finding suggests that UK ex-Service personnel with minoritised ethnic backgrounds are at an increased risk of problematic gambling behaviours. However, other evidence suggests that belonging to a minoritised ethnicity group is a protective factor against risky health behaviours. Although again not a primary focus, findings from one UK study demonstrates reduced rates of alcohol disorders in non-white military and civilian populations [2]. The inconsistency in findings, coupled with this lack of primary focus on understanding the experiences of minoritised ethnicity  ex-/Service personnel, reinforces the need for additional research on the ethnic and racial identities of UK Service and ex-Service personnel. 

Ongoing UK Research  

Whilst the US literature still dominates contributions to understanding experiences of minoritised ethnic Service and ex-Service personnel, UK research is increasing. However, one area that is significantly lacking is research explicitly considering the intersection of, simultaneously, being British and from a minoritised ethnicity. Acknowledging the lack of mutual exclusivity between these two identities and exploring the impact of this identity intersection can shed light on a population who are seemingly unrepresented in current literature.  In their Veterans’ Strategy Action Plan, The Office for Veterans’ Affairs (OVA) recognises the paucity of research on UK ex-Service personnel from minoritised ethnic backgrounds and has committed to broadening the evidence base on this topic. In response, the OVA have commissioned a project with researchers at The University of Warwick exploring the experience of individuals who have served in the UK Armed Forces who are from minoritised ethnic backgrounds.   

Considerations for future research:  

  1. The evidence base is distinctly lacking in research pertaining to the experiences of specific minoritised ethnic groups within the UK Armed Forces. For Western militaries especially, a great deal of research combines and compares all minoritised ethnicity experiences with those of the white majority [7]. Considering more granular divisions of populations would be beneficial as evidence shows that not only are there discrepancies between majority and minority ethnicities but that intra-ethnicity discrepancies are also present (e.g., [6] [10]).   
  2. Avoid conflating research into non-UK ex-/Service personnel with British minoritised ethnicity ex-/Service personnel. Similar to discrepancies between majority and minority ethnicities, there are likely to be differences in experiences between non-UK minoritised ethnic and British minoritised ethnic ex-Service personnel due to cultural, social, and historical contexts, resulting in the need for tailored and unique support. Thus, distinguishing between non-UK and UK minoritised ethnic ex-/Service personnel could help research to formulate a more accurate and complete understanding of the experiences and needs of such populations.  
  3. Identity intersectionality. Similar to being simultaneously black and British, or black and Afro-Caribbean, other aspects of identity should be considered alongside ethnicity. For example, US research highlights how minoritised ethnic ex-Service women are more likely to report military sexual trauma (MST) than minoritised ethnic ex-Service men [16], with black ex-Service women being the least likely to disclose instances of MST [17]. Considering how identity components such as gender and sexuality influence these experiences should also be a consideration for future research.   

Globally, there is evidence to suggest that Service and ex-Service personnel from minoritised ethnic backgrounds are disadvantaged compared to their majority ethnicity counterparts [7]. These disadvantages are not limited to an individual’s life whilst serving, and often remain present during and after transition.    

Despite accounting for over 10% of the total Serving population in the UK, research concerning individuals from minoritised ethnic backgrounds is somewhat lacking. Although the ongoing studies are a positive addition to the research landscape, especially when considering the mental health and wellbeing of individuals from minoritised ethnic backgrounds, more funding and research is still needed. Understanding the experiences of minoritised ethnic groups is not only advantageous on an individual level, but on an organisational level too. Whilst individual benefits including increased wellbeing, health, motivation, and productivity are likely to result from addressing minoritised ethnic inequalities, these are also vital for defence capability and wider organisations in order to be effective. As recognised in the Defence Diversity and Inclusion Strategy 2018 – 2030, diversity and inclusion is “critical” to ensuring The Whole Force is capable of meeting strategic objectives and are prepared to face evolving security challenges and threats.  

By exploring these experiences, we can increase recommendations for inclusive and equitable practices to diversify the military which simultaneously contributes to wider military effectiveness [18] and improved well-being of Defence personnel.  Future research should consider how former and current minoritised ethnic Service-personnel experience life in the military and the impact that these experiences have during and after Service if we are to influence and improve policy, practice and service provision for these individuals and their families.   

If you would like to keep up to date with current research and new publications of evidence about the UK Armed Forces community, please visit our Ongoing Research Page, our Repository, and sign up for our newsletter at the bottom of our homepage here.   

Many thanks to Sue Liburd (Black British Army Veteran, Equality Diversity and Inclusion Consultant & Researcher, Strategic Advisor on Veteran Affairs) for providing a thoughtful review of this news feature. 

 

  1. A guide to race and ethnicity terminology and language. (n.d.). Retrieved December 12, 2023, from https://www.lawsociety.org.uk/topics/ethnic-minority-lawyers/a-guide-to-race-and-ethnicity-terminology-and-language 
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