Ex-Servicewomen’s support needs and experiences accessing support services: A synthesis of recent evidence and recommendations for improvement

At the end of 2023, 13.6% of the 1.85 million United Kingdom (UK) Armed Forces ex-Service personnel were women. Despite this, only a few more than 50 research papers on military health and wellbeing include UK ex-Servicewomen ^[1]. However, in the last six-months, there have been several notable additions to evidence in this area with a particular focus on ex-Servicewomen’s experiences of accessing support services. These additions include the Anglia Ruskin University (ARU) ‘I don’t feel like that’s for me’ report ^[2] and three Office of Veterans Affairs (OVA) funded reports: another ARU contribution, titled ‘Where are all the women?’ ^[3]; the ENHANCE study, by researchers at Combat Stress ^[4]; and a report on ‘Improving access to service charities for female Veterans’, authored by researchers from Robert Gordon University (RGU) ^[5].

Although existing research highlights that UK ex-Servicewomen cite their gender as a barrier to seeking mental health support ^[6], these recent papers report on research that explored, in detail, the extent to which gender may contribute to unique post-Service experiences. This News Feature discusses these recent additions to our growing understanding of ex-Servicewomen with a specific focus on their post-Service experiences of accessing and utilising support services.

Veteran identity

A consistent finding across these recent reports is that not identifying with the Veteran identity is a commonly cited reason for ex-Servicewomen not utilising Veteran specific support services. Some of the contributing factors included not feeling worthy of the support due to not having fulfilled close combat roles nor having completed operational tours and feeling that Veteran specific support was tailored to men. In other instances, ex-Servicewomen felt that other aspects of their identity, such as being a mother, wife or a professional, were more notable than being a Veteran. Even in instances when ex-Servicewomen had accessed support, anecdotes suggested that Veteran services were male-centric and that an awareness of gender specific services needs to increase. Socially curated stereotypes that Veterans are typically older men was also seen as a barrier to accessing support services. Compounding this further was the reported influence of the media on public perceptions of the Veteran identity through the dominant presence of males in Veteran specific marketing materials.

However, the sentiment of not identifying with the Veteran identity was not unanimous amongst all ex-Servicewomen; some participants in ARU's 'Where are all the women?’ report ^[3] shared that identifying as a Veteran provided them with a sense of pride. However, this too may also influence post-Service support experiences for ex-Servicewomen. Specific to mental health support for military sexual trauma (MST), the Combat Stress’ ENHANCE study ^[4] references how military “conditioning” plays a key role in influencing the level of support an individual may or may not access upon leaving the Armed Forces. Findings from the research suggests that military attitudes towards help seeking behaviours are that help-seeking is seen as “weak” and not aligned with military values, and that help-seeking often leads to consequences such as losing your job or simply not being believed. Important to highlight in the context of this news feature is that this belief continued into post-Service life and was expressed as a barrier to ex-Servicewomen accessing support. Therefore, for ex-Servicewomen who do identify with this Veteran identity, these barriers and the aforementioned conditioning may be a particularly salient barrier.

Supported by the ENHANCE study ^[4], whose findings suggest that females might actually prefer more generic support services, it is apparent that a consideration for individualised care, including options for treatment, the consideration of non-military factors, and a variety in the type of support services and mechanisms available, would be beneficial for ex-Servicewomen.

Perhaps, even for those who do identify as a Veteran, the male-centric nature of support services aimed at ex-Service personnel coupled with both public and military perceptions of what it is to “be a Veteran” are more impactful than the association with the Veteran identity itself. Usefully and importantly for policy and practice, several recommendations to address these potential shortcomings of support services have been suggested in these recent reports, for example:

1. Deploy a training programme and/or learning resources for healthcare providers to increase awareness of ex-Servicewomen and the uniqueness of their military Service experiences and healthcare needs ^[4][5]. This could also be done at a general population level as to address potentially bias public perceptions of ex-Service personnel – for example a public awareness campaign that would also be seen by healthcare providers ^[3].
2. Ensure appropriate representation of women in support services that target ex-Servicewomen, in both practice (e.g., clinicians) and awareness (e.g., branding, promotional materials) ^[2][3].

Military sexual trauma (MST):

Combat Stress’ Enhance study ^[4], focussing on improving access to evidence-based treatment for ex-Servicewomen, further highlights the need for an individualised approach to treatment. As well as interviews with ex-Servicewomen, this report consists of a systematic review of treatments for MST-related Post-traumatic stress disorder (PTSD) in ex-Servicewomen. Both trauma-focussed therapies, including cognitive processing therapy (CPT) and prolonged exposure (PE), and non-trauma focussed therapies (i.e., those that do not focus specifically on the traumatic experiences themselves), such as trauma sensitive yoga, were found to be effective at reducing PTSD symptoms. With recent research demonstrating that evidence-based treatment is a facilitator to service access, transition support and service providers should consider avenues that might allow for more personalised transition plans, especially in populations that may have more complex or clinical needs ^[5]. ARU’s ‘I don’t feel like that’s for me’ report ^[2] highlights that, for ex-Servicewomen, MST was not the only contributor in ex-Servicewomen having clinical support needs. Whilst Service-related sexual assault and harassment had resulted in mental health challenges, instances of discrimination and bullying and unsupportive management were also cited as contributing factors.

Recommendations in these recent reports for research, policy, and practice to improve ex-Servicewomen’s treatment outcomes include:

1. Women Veteran or MST-only support options: ex-Servicewomen who have experienced MST may be particularly at risk of not accessing support groups if the group environment reflects a masculine and military culture ^[4]. For some ex-Servicewomen, even the waiting rooms of support services can serve as a reminder and instil feelings of returning to the site of bullying and harassment ^[5].
2. Surplus to MST, detrimental impacts on Servicewomen were related to other gender specific health events including pregnancy, having children and the menopause. The research calls for a continued evaluation, and subsequent use of the findings, to inform improvements in Servicewomen’s experiences ^[5].

It’s not just mental health:

The ‘I don’t feel like that’s for me’ report ^[2] acknowledges that challenges are not limited to in-Service experiences and mental health. Transition related difficulties in adapting to civilian life, and gender specific differences in other support provisions have also been reported.

Whilst this news feature has largely focussed on barriers to accessing support services, it is important to note that ex-Servicewomen do report positive transition outcomes because of their military experiences. In the ARU ‘Where are all the women?' report ^[3], ex-Servicewomen cited that successful transitions were influenced by financial support including help-to-buy schemes that they were made aware of through their time the Armed Forces ^[3], with another benefit of being able to save money, reported in the research from RGU ^[5].  However, for specific sub-groups of ex-Servicewomen, the positive nature of these experiences may be impacted. For example, the ‘Where are all the women' report ^[3] also found that single mothers faced additional challenges finding accommodation and managing their expenses, suggesting tailored support for this sub-population may be needed to facilitate successful transition. Whilst it’s possible that ex-Servicemen face the same challenges as women, combining generic transition struggles with female-gender-specific challenges (e.g., being a primary caregiver) may exacerbate the impact of these. Research should consider gendered experiences comparatively.

Another female sub-population who may not reap the intended benefits of transition support are female Armed Forces personnel who are leaving the military to have a baby as the employment support offered to them through, for example The Career Transition Partnership (CTP), may not be immediately relevant. CTP support is available for all Service personnel for two years after leaving the military but females who do not seek civilian work within these two years are subsequently disadvantaged in their support provision. For example, should an individual opt to remain at home with her child past her maternity leave, she may not capitalise on career support, such as interview preparation, that is offered through CTP. One participant called for an option to ‘defer’ transition support to ensure that gendered experiences do not limit the ability for these policies to result in equitable outcomes ^[5].

Across the reports, ex-Servicewomen highlighted that post-Service experiences of support systems were most positive when charities and statutory organisations combined their efforts to address support needs that were interconnected. ‘Structural elements of care provision’ were a focus of the Combat Stress ENHANCE study ^[4] and the research highlights the difficulties associated with the myriad of support services available to ex-Service personnel and the sense of overwhelm that can accompany being proactive about seeking support. In their ‘Where are all the women’ report ^[3], ARU researchers suggest a single online directory for Veterans’ services for women, although they acknowledge that adapting and keeping this up to date would not be straightforward. The ongoing streamlining of the Veterans Gateway and the transition of this into government by the OVA may contribute to the improvement of information about and access to support services. However, despite the presence of the Veterans Gateway and its aim to be the ‘first point of contact for Tri-Service Veterans and their families’, ex-Servicewomen in the reports were also turning to alternative online platforms, social media, and relying on peer support networks to gather their information. Whilst continuing to attempt to centralise support service information is likely beneficial, providers should be aware that these central hubs may not always be the first point of contact as intended.

Similar to recommendations focussing on mental health, the following suggestions have been made across the recent reports to improve policy and practice promoting support service access for ex-Servicewomen:

1. Review, and co-produce, the existing Ministry of Defence (MOD) resettlement and transition provision for female Service personnel, with a focus on providing detailed guidance on housing and employment support ^[3].
2. Research should focus on highlighting what services are available for ex-/Servicewomen, establishing their current use, and where content and access to these services may be further improved.
3. Service charities might consider collaboratively working to ensure that interconnected needs, such as employment, housing, and mental health (including gender specific health concerns), are concurrently and holistically addressed ^[5].

So, what now?

The recent research has provided a springboard of recommendations for research, policy, and practice to address the gaps in understanding and addressing the experiences of accessing support services for UK ex-Servicewomen. However, it remains clear that there is more work to be done. In response to the three OVA funded reports by Combat Stress, Robert Gordon University and Anglia Ruskin University, the OVA have pledged a further £200,000 to enhance access to and improve clinical support for ex-Servicewomen who have experienced MST. This funding will help move theory to practice via the development and rollout of training for frontline staff within the UK healthcare and charity sector and will support the Women Veterans’ Strategy that is due for publication in Spring 2024. Although a positive injection, additional research and research funding should also focus efforts on other areas and support needs highlighted by the four recent reports. Prospective areas of interest beyond MST experiences might include broader resettlement provision, the impact of military Service as a gender-minority, and training and education for healthcare professionals working with ex-Servicewomen.

Additional research should also be conducted to ensure that a diverse range of experiences are captured. Whilst the four papers in focus offer the opportunity to gain in-depth insight through their qualitative natures, the sample sizes are relatively small with the number of interviews conducted ranging from 19 to 85. Furthermore, the majority of the samples consisted of White British females and as recent research suggests, ex-Service personnel from minority ethnic groups may have unique experiences that should also be considered.

This news feature has focussed on four recent reports but the effort towards increasing understanding about current and former Servicewomen is not limited to these. Multiple research projects focussing on the experiences of female ex-/Service personnel are currently ongoing in the UK . For more information about these, please visit our ongoing research page. You can also search our repository for more international research and policy documents on ex-/Servicewomen.

If you or someone you know would like to access help, advice or support, there are a number of charities and organisations that offer support for ex-Servicewomen:

• Specialist NHS service, OP Courage, provides support and treatment for ex-Service personnel and individuals due to leave the Armed Forces, and their families.
• Veterans Gateway, a 24/7 service offering advice and support for ex-Service personnel and their families.
• Salute Her UK is a “gender specific” support service offering mental health therapy and interventions for current and former Servicewomen who have been affected by sexual assault, bullying and harassment.

*The recommendations highlighted in this news article are only a selection of those formulated in the mentioned reports.

References:

[1]. Fossey, M., Godier-McBard, L. and Gillin, N. (2021). We Also Served: The Health and Well-Being of Female Veterans in the UK. Veterans & Families Institute, Anglia Ruskin University. (link)

[2]. Wood, A., Fossey, M., Price, P., Powell, D., Chalkley, H., Davidson, M. and Godier-McBard, L. (2023). I don’t feel like that’s for me: Overcoming barriers to mental healthcare for women veterans. Centre for Military Women’s Research, Anglia Ruskin University. (link)

[3]. Hooks, C., Morgan, L., Fossey, M., Buxton, E. and Godier-McBard, L. (2023). ‘Where are all the women?’ Recognition and representation – UK female veterans’ experiences of support in civilian life. Centre for Military Women’s Research, Anglia Ruskin University. (link)

[4]. Campbell, G, M. and Murphy, D. (2023). ENHANCE Study: Improving access to evidence-based treatment for women veteran survivors of sexual trauma. Research Department, Combat Stress. (link)

[5]. Bailey, M., Phillips, R. and Morrison, Z. (2023). Improving access to service charities for female veterans. Robert Gordon University. (link)

[6]. Godier-McBard, L., Cable, G., Wood, A. D. and Fossey, M. (2022). Gender differences in barriers to mental healthcare for UK military veterans: a preliminary investigation. BMJ Military Health. (link)