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Written evidence submitted by King's Centre for Military Health Research.
For the current submission, we have summarised past and on-going research evidence from the King’s Centre for Military Health Research (KCMHR) based at King’s College London (KCL). In particular, we have included preliminary evidence from on-going studies at KCMHR relating to the health and wellbeing of female, ethnic minority and sexual and gender minority serving and ex-serving personnel thereby highlighting its relevance to the Armed Forces Covenant, and potential implications and recommendations. Links to KCMHR key papers are integrated in the text, with full references in Appendix 1.
King’s Centre for Military Health Research
KCMHR is the leading independent civilian UK centre of excellence for military, veteran and family health research. KCMHR was established in 1996 as a joint initiative between the Institute of Psychiatry, Psychology & Neuroscience and the Department of War Studies, King’s College London. KCMHR draws upon the experience of a multi-disciplinary team led by Professor Sir Simon Wessely and Professor Nicola Fear. The KCMHR flagship cohort study - ‘The Health and Wellbeing of the UK Armed Forces’, has followed those who served in the Iraq and Afghanistan conflicts since 2003 and now provides longitudinal data on their health and wellbeing outcomes, spanning over 20 years. Findings are regularly reported in the press and help shape UK Government policy towards serving and ex-serving personnel and their families, as well as other occupational groups.
Short Summary
The Armed Forces Covenant (AFC) has made positive progress in supporting serving, ex-serving personnel and their families across several areas such as healthcare, employment, education and housing. However, gaps remain in addressing the needs of service and ex-servicewomen, serving and ex-serving personnel from ethnic minority backgrounds, and lesbian, gay, bisexual, trans, queer and other sexual and gender minorities (LGBTQ+). Research conducted at KCMHR identified disparities in outcomes for service and ex-servicewomen and Gurkha and Fijian serving and ex-serving personnel. These include experiences of discrimination, barriers to promotion, sexual harassment/assault, inadequate healthcare provision, difficulties in adapting to civilian settings following transitions, financial barriers and access to social services. Tailored interventions and guidance and evaluation of support initiatives are essential to measure progress and ensure that the needs of all members of the community are met.
The AFC is working well in areas such as healthcare, employment, education and housing. For example, 98% of NHS Trusts and foundation trusts in England are now part of the Veteran Healthcare Covenant Alliance, a group of NHS providers that have volunteered to be exemplars of the best care and support to the Armed Forces community (1). The Veteran Healthcare Covenant Alliance is currently piloting accreditation schemes with providers outside of the NHS (1). This highlights the recognition of the unique healthcare needs of ex-serving personnel. Additionally, the Veteran friendly GP accreditation scheme, launched to increase awareness among primary healthcare providers about the specific health challenges faced by the Armed Forces community, has led to 98.1% of primary care networks to have at least one veteran-aware GP practice in their area (1). An evaluation of the scheme found it to be effective and beneficial to ex-serving personnel (2).
The Employer Recognition Scheme (ERS) is another example of a successful implementation that encourages businesses to recognise the efforts and skills acquired by Reservists and ex-serving personnel whilst in service to support them in civilian life.
The Covenant also provides support to families, ensuring that children of serving members are not at disadvantage when accessing education. For example, it provides additional support for securing a place at a new school if they are required to move during the academic year due to their parent’s service (1). Additional funding to programmes such as The Early Years Programme and The Service Pupil Programme was given in 2024 to further support children’s educational outcomes (1). Furthermore, the Covenant ensures that injured personnel receive priority to appropriate housing schemes. This commitment is reflected in government policies that give priority for social housing to injured and bereaved personnel (3). Moreover, 773 ex-serving personnel at risk of homeless have been supported through Op FORTITUDE since September 2023, demonstrating the effectiveness of targeted initiatives in addressing challenges post-service (1).
Overall, the AFC has made progress in reducing barriers for serving and ex-serving personnel and their families when accessing support services whilst in service, during transition and beyond.
The AFC could make more progress to adequately support the needs of underrepresented groups in the Armed Forces Community such as service and ex-servicewomen and serving and ex-serving personnel from ethnic minority backgrounds, and lesbian, gay, bisexual, trans, queer and other sexual and gender minorities (LGBTQ+). Challenges experienced whilst in service can have an impact on transitions outcomes, leading to difficulties integrating into civilian settings and subsequent poor mental health and wellbeing (4-6).
Research conducted by KCMHR, such as the SUSTAIN project (SUpporting Successful TrAnsItioN), led by Professor Nicola Fear and Dr Sharon Stevelink, which explored the experiences of ex-servicewomen, the HEAR study (‘The Mental health and wellbeing of UK Gurkha and Fijian veterans’) led by Professor Edgar Jones, which examined the wellbeing of Gurkha and Fijian ex-serving personnel, and a PhD study focusing on the health and well-being of UK LGBTQ+ serving and ex-serving personnel, led by Sarah Rabin, identified areas where there is a lack of tailored guidance for underrepresented groups within the Covenant.
Ex-servicewomen
The SUSTAIN project funded by the Forces in Mind Trust explored the experiences of ex-servicewomen who have transitioned out of the UK Armed Forces. The project investigated the challenges ex-servicewomen face and what support could be provided to ensure that their needs are considered and addressed. The SUSTAIN project comprised of a systematic review of the literature, a scoping review of services of ex-servicewomen, discussions with stakeholders, interviews with ex-servicewomen and a quantitative comparison between ex-servicewomen and men and ex-servicewomen and civilian women and a scoping review of interventions from policy to individual level interventions such as apps. This data was triangulated, and a series of recommendations were made. The final SUSTAIN report will be published in March 2025, with additional scientific outputs expected throughout 2025. The SUSTAIN team at KCMHR are happy to have any private conversations with the committee in advance of that.
As part of the project, a systematic review was conducted looking at the impact of gender on military-to-civilian transitions. The majority of the studies included in the review were conducted in the United States (US), with one study including participants from both the US and Israel. Two studies were from the UK, while Canada and Australia each contributed one study (4). Therefore, findings from non-UK studies may not be fully representative of the UK context. Nonetheless, this highlights the need to further examine the role of gender in transition outcomes specific to the UK Armed Forces. The review found that some women felt forced to leave the military due to lack of promotion opportunities, being side-lined after taking family leave or in circumstances where family commitments overlapped with military duties (4). Other women reported leaving due to sexual discrimination, harassment, or assault (4). Women also struggled with gender norms, particularly with the discordance between adapting to masculine military norms and the expectations of feminine identify in civilian settings (4). Some women noted that gender disparities, discrimination and sexual assault in service negatively affected their development of a female veteran identity and subsequent integration to civilian settings and access to support (4). Participants also reported poor understanding by healthcare providers of their specific needs as ex-servicewomen (4). This highlights the need for the AFC to provide clearer guidance and accountability for healthcare providers to ensure they understand and address the specific needs of ex-servicewomen effectively.
The experiences of women highlighted in the review were echoed in conversations with stakeholders from the third section, NHS and Government (7) and in the interviews with ex-servicewomen. In particular, the following areas were highlighted where women were not being treated fairly or were facing inadequacies in-service and post-service:
Sexual discrimination, harassment and assault: There were reports from stakeholders and ex-servicewomen of experiences in-service which covered the spectrum of misogyny from discriminative practices to less commonly but still reported, sexual assault (7). Multiple ex-servicewomen reported that colleagues often told women they were not fit for the job or were weak (7). They highlighted that throughout their service, facilities were not equipped for women such as a lack of sanitary bins and ill-fitting uniforms that were not designed for women’s anatomy (7). These experiences led to a distinct perception from ex-servicewomen that they did not belong in service.
Services designed for men: The healthcare services in-service were described as unprepared for women’s health issues such as pregnancy, endometriosis and menopause which meant many women felt they had to navigate these issues with little support from the Armed Forces. In the civilian world, stakeholders described the veteran service provision as ‘male-orientated’ (7). They believed services used language and imagery geared towards men. In addition, they believed not all services were aware of issues that women, regardless of service, face such as menopause (7). Ex-servicewomen also echoed these sentiments as well as noted that civilian services did not always understand them due to their service, so they found themselves in a “state of limbo” when accessing civilian services. Overall, SUSTAIN found that the AFC gives no guidance on how best to support women's needs. We argue that to fully respect The Covenant Legal Duty, the AFC must guide organisations to support minority groups including women as opposed to treating the Armed Forces community as a homogenous group. This could include ensuring individuals and organisations who support ex-servicewomen are aware of health issues and experiences that may require more tailored support.
Employment opportunities: Due to the sexism some faced in service, women reported that they adopted ‘masculine’ traits to fit in with military culture. They then struggled when they joined the civilian workplace as these traits were seen as too ‘brash’. Ex-servicewomen also reported experiencing problems with self-confidence, possibly as a result of having to prove they were good enough in-service. In addition, some ex-servicewomen suggested that the Career Transition Partnership focused mainly on high-paced, high-earning career tracts which whilst may suit some women, did not cater for the needs of all.
The term ‘veteran’: Previous research (8) and evidence from the SUSTAIN project indicated that ex-servicewomen do not relate to the term veteran. In the SUSTAIN interviews, some women reported that this word conjures pictures of WW2 male veterans but does not represent them. Some also described their service as a job or ‘time in their life’ rather than as part of their identity which might go some way in explaining why they do not resonate with this term. However, the term veteran is commonly used by the AFC and organisations that sign up to the Covenant and therefore the Covenant could improve on guiding organisations to use more inclusive language.
Disparities in outcomes: The SUSTAIN project also included a comparison between male and female ex-serving personnel who have more recently transitioned using data from the KCMHR Health and Wellbeing Cohort Study. Comparative civilian datasets (Biobank and Annual Population Survey) were used to explore differences between female ex-servicewomen and their civilian counterparts. In the comparison of ex-servicemen and women, a lower proportion of ex-servicewomen were Senior Commissioned Officers compare to ex-servicemen. When compared to civilian women, ex-servicewomen were more likely to report poorer general health and more likely to report osteoarthritis compared to civilian women. In addition, ex-servicewomen were more likely to report experiencing intimate partner violence and sexual assault compared to civilian women. The reasons for these disparities are currently not known and it is likely that they will be complex and multi-faceted. However, the AFC reports rarely present data stratified by gender or ethnicity, so it is difficult to ascertain where the AFC’s strategies are improving outcomes for women or other minority groups specifically.
Previous KCMHR studies found similar results in terms of challenges reported by service and ex-servicewomen both in and after service, such as poor understanding of their healthcare needs and experiences of sexual discrimination, harassment and assault (9-11). These results are noted in our previous submissions to the Defence Committee to the inquiry, ‘Women in the Armed Forces: From Recruitment to Civilian Life’ (February 2021, https://committees.parliament.uk/writtenevidence/22222/pdf/)
and ‘Women in the Armed Forces: Follow Up’ (October 2023, (https://committees.parliament.uk/writtenevidence/125953/pdf/).
Gurkha and Fijian ex-serving personnel
The HEAR study, funded by Forces in Mind Trust, examined the health and wellbeing of Gurkha, Fijian and British ethnic minority serving and ex-serving personnel and compared outcomes with their white British counterparts. The study also qualitatively investigated the experiences of Gurkha and Fijian ex-serving personnel in the UK Armed Forces. Gurkha ex-serving personnel were included because of their extensive military service, whilst Fijian ex-serving personnel were chosen because they are the largest national group within Commonwealth serving personnel in the UK Armed Forces.
Pension disparities: The study explored the impact of pension disparities for Gurkha ex-serving personnel who served in the UK Armed Forces before 1997 in terms of their mental health and wellbeing. Although Gurkhas were granted pension parity in 2007 with UK nationals serving in the Armed Forces, this did not apply to service before 1997 when they had their headquarters in Hong Kong. Ex-serving personnel receive a pension of between 23% and 36% of the value of that paid to an equivalent British ex-serving member, depending on their rank, based on the assumption that they would return to Nepal after military service. However, after being allowed to settle in the UK with their families in 2009, many of them now experience financial hardship as a consequence of a pension paid at a significantly lower value. Despite an on-going campaign driven by a deep sense of unfairness, the last review of 2023 failed to recommended change and there are no plans to review the financial arrangement.
Financial barriers: Gurkha and Fijian serving personnel often seek to remain in the UK after service. However, both the ‘right to remain’ and the ‘right to enter’ applications cost £2,885 per person and therefore create financial barriers for those who have served.
Access to social services: Gurkha ex-serving personnel who served before 1997 have limited access to social services, such as housing and healthcare, despite having had National Insurance contributions deducted from their service pay. Whilst this anomaly has been corrected for current serving personnel, it is crucial that pre-1997 Gurkhas are not at disadvantage.
Barriers to promotions: Gurkha and Fijian ex-serving personnel reported barriers to promotions. Both qualitative and quantitative findings found that white British serving personnel hold higher ranks compared to Gurkha and Fijian samples. No Gurkha or Fijian officer has yet to be promoted to colonel, in part a consequence of having their rank historically capped at major. The rate of promotion for other ranks and NCOs was also found to be noticeably slower than for UK nationals in equivalent units. While transfers to other units for career development are now allowed, some restrictions remain in place; Gurkhas, for example, have to serve five years in a Gurkha unit before requesting a transfer.
LGBTQ+
The PhD study funded by the London Interdisciplinary Social Science Doctoral Training Programme, in partnership with the Royal British Legion, is examining the health and wellbeing of UK LGBTQ+ serving and ex-serving personnel. This project specifically focuses on the experiences of those who joined and served after the ban on LGBTQ+ personnel was lifted in 2000, which, to the best of our knowledge, has not been studied to date. As part of this project, a systematic review is being conducted to collate quantitative research on mental health outcomes of 5EYES (Australia, Canada, New Zealand, US, UK) LGBTQ+ serving and ex-serving personnel in their respective post-ban eras. This review has identified only three papers across all 5EYES countries (and none from the UK) that meet inclusion criteria, further highlighting the need for future research.
This PhD will also include conducting quantitative and qualitative studies. The quantitative study will use secondary data from KCMHR’s cohort study of the health and wellbeing of UK Armed Forces personnel to examine the prevalence of, and factors associated with, mental health outcomes and their relationship to sexual orientation and gender identity. Phase 4 (2022-2023) of the KCMHR cohort study asked about LGBTQ+ identity for the first time (12). The qualitative study will include conducting 30-40 interviews with UK LGBTQ+ serving and ex-serving personnel who joined and served solely in the post-ban era. This will allow for greater nuance and deeper understanding of LGBTQ+ serving and ex-serving personnels’ lived experiences and the factors that influence these experiences using qualitative methods. Interviews will cover questions related to pre-military experiences (i.e., reasons for joining, whether the participant was “out” to anyone, family relationships), experiences during the military (i.e., deployment, disclosure of LGBTQ+ identity to fellow UKAF personnel, discrimination, impacts of heteronormative culture), and post-military experiences where relevant (i.e., reasons for leaving, how LGBTQ+ identity has evolved, current support systems).
The Ministry of Defence (MoD) reports on the progress of the AFC annually with input from external organisations (13). The reports focus on key topics including healthcare and employment for example. There is mention of support and progress for service and ex-servicewomen in the most recent 2024 report, such as the introduction of menopause and breastfeeding policies to sustain operational effectiveness. However, we suggest that future reports consistently report progress for women, ethnic minority and LGBTQ+ personnel across all their thematic sections as standard. Moreover, it would be beneficial to evaluate the effectiveness of these policies against a clear set of objectives to measure progress.
The AFC is also measured at an organisational level through the ERS in which employers are awarded on a three-tier recognition scheme (Bronze, Silver, Gold). Employers are rewarded for pledging, demonstrating or advocating support to defence and the Armed Forces community, and aligning their values with the AFC (14). There is, however, no measure of how well organisations support women, ethnic minority and LGBTQ+ personnel. Do organisations know enough about minority groups to effectively fulfil the AFC and due regard in provision of services and support? While the ERS is a valuable initiative, evaluation of how employers actively support ex-serving personnel would be beneficial, particularly of minority groups who may have diverse needs and require tailored support.
Overall, we suggest that more specific attention should be given to service and ex-servicewomen, Gurkha and Commonwealth (Fijian being the largest element) and LGBTQ+ serving and ex-serving personnel, throughout the implementation of the AFC. We suggest monitoring, evaluation and guidance should integrated into AFC toolkits to hold the MoD accountable for progress, and support organisations to better understand and support these groups. Moreover, these efforts should be extended to public bodies and agencies, such as the NHS, to expand accountability for the effective implementation of support initiatives.
Yes, there are areas which the AFC could be extended to. The AFC focuses on key areas such as access to healthcare, housing, education, and employment to ensure that serving, ex-serving personnel and their families are not at disadvantage because of their service. The AFC also supports transitions post-service and reintegration into civilian life. Whilst women, ethnic minority and LGBTQ+ serving and ex-serving personnel are included in the AFC, we believe more attention should be paid to their needs within the Covenant alongside clear guidance on evaluating support initiatives. This would lead to beneficial outcomes in terms of operational readiness, effectiveness, recruitment and retention of all serving personnel as well as support successful transitions for ex-serving personnel irrespective of their gender, sexual orientation and ethnicity.
As highlighted in the SUSTAIN project, women in the Armed Forces face unique challenges in the healthcare system, such as poor understanding of gender-specific conditions both in and post-service (4, 7). Other challenges include sexual harassment/assault, difficulties in transitioning to civilian employment and identifying with the term ‘veteran’ (4, 7). These issues often stem from non-inclusive military cultures in service and can have a profound impact on the health and wellbeing of service and ex-servicewomen, exacerbating difficulties transitioning to civilian life (4). Therefore, while it is important that the AFC provides additional guidance on how to support the inclusion of women personnel in military settings, guidance alone is not sufficient. These areas require tangible interventions and actionable measures to address and resolve these issues, ensuring that inclusion is not just considered but actively enacted. This aligns with the principles of the AFC of fair treatment and no disadvantage. Moreover, these areas are important for consideration not only to improve health outcomes of service and ex-servicewomen but to also increase recruitment and retention. By creating a more inclusive environment where their needs are met, the Armed Forces can attract more women to join, in line with their commitment to be a more diverse and inclusive community. Additionally, given our findings indicating that ex-servicewomen do not identify with the term ‘veteran’, we recommend adopting a more inclusive terminology within the AFC to ensure all members of the community feel represented.
The HEAR study revealed inequalities in pension provision, career progression and access to social services for Gurkha and Fijian ex-serving personnel compared to their white British counterparts. The issues faced by Fijian ex-serving personnel reflect those of all Commonwealth ex-serving personnel, Fijians being chosen in the study because they are the largest national group. These findings highlight structural disparities that do not align with the Covenant’s core principles. Similarly to the safeguard of women, the AFC should expand its guidance to these areas as well as promote the implementation of interventions and legislation to support Commonwealth ex-serving personnel.
The PhD study on the health and wellbeing of UK LGBTQ+ serving and ex-serving personnel has found a dearth of research and resource devoted to these populations. Most of the post-ban evidence on LGBTQ+ military personnel health and wellbeing comes from the US, which found that even after their ban was lifted, the mental health impacts (including posttraumatic stress disorder [PTSD], depression, suicidal ideation and attempts, and alcohol misuse) were not over, (15, 16), further necessitating the need for research into this historically overlooked community in the UK. Moreover, the MoD Defence Diversity and Inclusion Strategy (2018-2030) seeks to increase the number of LGBTQ+ personnel at all levels, to increase retention of LGBTQ+ personnel, to understand the diversity of all its people, and to eliminate bullying, harassment, and discrimination amongst all UKAF personnel (17). By specifically focusing on LGBTQ+ personnel, this will contribute to understanding about an underrepresented population, help inform support and service provisions for this population and assist the MoD in delivering outcomes outlined in the Defence Diversity and Inclusion Strategy 2018-2030 (17). As there is limited research into the experiences of UK LGBTQ+ personnel, starting to examine the needs of these groups is essential.
Areas such as inequalities in healthcare provision, challenges related to sexual harassment and assault, disparities in pension provision and access to social services for Commonwealth ex-serving personnel, and the unique needs of LGBTQ+ personnel, should therefore be considered in the AFC because they would address critical gaps in equality and ensure that all members of the Armed Forces Community are supported. Expanding the AFC would uphold its principles of fairness and respect and would demonstrate that the contribution to the country of serving and ex-serving personnel are recognised.
To guarantee that the AFC fulfils its commitments, the Covenant should provide more specific guidance to statutory organisations on how to best serve minority groups. As identified in our studies, statutory organisations should be equipped with implementation frameworks. These should include practical tools and guidance on how to implement and assess the effectiveness of interventions that address healthcare needs, promote cultural inclusivity, and support successful transitions to civilian life. Evaluation is essential to measure the effectiveness of policies introduced to support the Armed Forces community, and it is crucial that statutory organisations are provided with a clear set of objectives to meet for clearer guidance. Incorporating monitoring and evaluation practices into the AFC toolkits will not only provide statutory organisations with a better understanding of how to effectively support service and ex-servicewomen and minority groups such as Gurkhas and Fijians and LGBTQ+ serving and ex-serving personnel but it will also hold the MoD accountable to track progress.
Legislation changes should be made to address pensions disparities for Gurkhas who served before 1997, as well as expanding access to social services to this group. The Covenant should suggest reducing the number of years of service required to request unit transfers for career development purposes for Gurkha serving personnel, to ensure they have the same promotion opportunities as white British serving personnel.
The extension of the AFC legal duty to central government and devolved administrations would ensure that they both had the legal responsibility to make sure that policies and services take into account the needs of all members of the Armed Forces Community, including serving and ex-serving personnel and their families regardless of their gender, sexual orientation or ethnicity. Moreover, this would have the potential to help tackle social disparities that currently exist between regions across the country.
Extending the legal duty would also ensure that women, ethnic minority and LGBTQ+ personnel receive the adequate care and support they need and overall improve their experiences both in service and after service. Further, integrating principles of Equality, Diversity and Inclusion (EDI) into the AFC could support addressing social inequalities within the Armes Forces community. The Fairer Scotland Duty which requires public sector bodies to actively consider reducing inequalities of outcome can provide a useful framework to support the effectiveness of the Covenant.
Appendix 1- References
1. UK Government. The Armed Forces Covenant Annual Report 2024. 2024. Available from: https://assets.publishing.service.gov.uk/media/676049dc1857548bccbcfacd/Armed_Forces_Covenant_annual_report_2024.pdf
2. Finnegan A, Salem K, Ainsworth-Moore L, Randles R, West L, Simpson R, et al. An evaluation of the veteran friendly practice accreditation programme. BJGP Open. 2022:BJGPO.2022.0012.
3. UK Government. Improving access to social housing for members of the Armed Forces 2024 Available from: https://www.gov.uk/government/publications/improving-access-to-social-housing-for-members-of-the-armed-forces/improving-access-to-social-housing-for-members-of-the-armed-forces
4. Smith A, Rafferty L, Croak B, Greenberg N, Khan R, Langston V, et al. A Systematic Review of Military to Civilian Transition: The Role of Gender. medRxiv. 2024 Feb 23:2024-02.
5. Harvey SB, Hatch SL, Jones M, Hull L, Jones N, Greenberg N, et al. The Long-Term Consequences of Military Deployment: A 5-Year Cohort Study of United Kingdom Reservists Deployed to Iraq in 2003. American Journal of Epidemiology. 2012;176(12):1177-84.
6. Burdett H, Fear NT, Wessely S, Greenberg N, Rona RJ. Contribution of mental ill health during military service to postservice benefit claims in the UK. Occupational and Environmental Medicine. 2021;78(9):643-7.
7. Croak B, Rafferty L, Sharp M-L, Smith A, Khan R, Langston V, et al. Barriers and facilitators to successful transition to civilian life for ex-servicewomen: the perspective of service providers and policymakers. medRxiv. 2024:2024-08. 2024.
8. Burdett H, Woodhead C, Iversen AC, Wessely S, Dandeker C, Fear NT. “Are you a veteran?” Understanding of the term “veteran” among UK ex-service personnel: A research note. Armed Forces & Society. 2013;39(4):751-9.
9. Campbell GM, Williamson V, Murphy D. “A Hidden Community”: The Experiences of Help-Seeking and Receiving Mental Health Treatment in UK Women Veterans. A Qualitative Study. Armed Forces & Society. 2025;51(1):22-45.
10. Hendrikx LJ, Williamson V, Murphy D. Adversity during military service: the impact of military sexual trauma, emotional bullying and physical assault on the mental health and well-being of women veterans. BMJ Mil Health. 2023;169(5):419-24.
11. Baumann J, Williamson C, Murphy D. Exploring the impact of gender-specific challenges during and after military service on female UK Veterans. Journal of Military, Veteran and Family Health. 2022;8(2):72-81.
12. Sharp M-L, Jones M, Leal R, Hull L, Franchini S, Molloy N, et al. Health and well-being of serving and ex-serving UK Armed Forces personnel: protocol for the fourth phase of a longitudinal cohort study. BMJ Open. 2023;13(10):e079016.
13. UK Government. Armed Forces Covenant: annual reports 2017 [updated 18 December 2024. Available from: https://www.gov.uk/government/collections/armed-forces-covenant-annual-reports.
14. UK Government. Armed Forces Covenant. Available from: https://www.armedforcescovenant.gov.uk/.
15. Holloway IW, Green D, Pickering C, Wu E, Tzen M, Goldbach JT, et al. Mental Health and Health Risk Behaviors of Active Duty Sexual Minority and Transgender Service Members in the United States Military. LGBT Health. 2021;8(2):152-61.
16. Tucker RP. Suicide in Transgender Veterans: Prevalence, Prevention, and Implications of Current Policy. Perspect Psychol Sci. 2019;14(3):452-68.
17. UK Government. Defence diversity and inclusion strategy 2018 to 2030: A force for inclusion 2018 Available from: https://www.gov.uk/government/publications/defence-diversity-and-inclusion-strategy-2018-to-2030-a-force-for-inclusion.
24th January 2025