We were delighted to welcome the Princess Royal to the 25th anniversary conference of KCMHR. Over that time we have become the most trusted source of independent high quality information on the health and well being of the Armed Forces, past and present. We have established an international reputation for our work. Of the four people with the highest global publications in the field, three are from KCMHR.
Professor Sir Simon Wessely
04 June 2024
The King’s Centre for Military Health Research (KCMHR) is the main source of independent high-quality data on the mental health and wellbeing of the UK Armed Forces, both serving and ex-serving, and their families and is the UK’s centre for research excellence. Its long and outstanding research has deeply and positively impacted the whole Armed Forces community.
Since 2004, King’s has conducted a cohort study of more than 8000 UK military personnel, including those who have left Armed Forces. This work has consistently shown that the vast majority of those who have served do not experience mental health problems during or after service.
However, in a later stage of the study conducted in 2014-16, there was a modest increase in PTSD (from 4% to 6%), with the greatest increase in the ex-serving personnel who had previous experience of combat deployments to Iraq or Afghanistan (17%). This highlighted the importance of ongoing support following discharge from military service.
The “mad, bad and sad” stereotype of military personnel
People who have served in the UK Armed Forces are often referred to as being “mad, bad and sad” - the media led stereotype. This narrative can be damaging to the health and wellbeing of personnel, reduces their employment prospects post-service, and increases stigma.
KCMHR’s academics have worked to produce research to help reduce this stigma. For example, while there have been frequent reports of ex-serving military personnel being imprisoned, King’s research found lower lifetime prevalence of offending among military men compared to similarly aged men in the general population. The team identified frequency and patterns of offending in military personnel and the general population that showed an overall age-standardised difference of 1.7% versus 7.0%, respectively.
However, this data also drew attention to the exception – higher levels of violent offending by military males compared to males in general population, particularly in younger age groups, which was partly linked to traumatic combat exposure and mediated by alcohol misuse and PTSD.
Military personnel also seek mental health support
There is a popular belief that military personnel are more reluctant than other groups to seek help, but King’s research showed otherwise.
After looking at the behaviours of over a thousand military personnel and veterans who reported symptoms of mental disorder they showed a steady increase in help-seeking; more than half had accessed medical support over the lifetime of the cohort and 86% had used informal support.
King’s research also showed that barriers may change over time and depending upon an individual’s circumstances, highlighting the importance of understanding barriers to help-seeking when designing mental health services.
Improvements and investment in mental health services for military personnel and veterans
By demonstrating the extent of mental health needs within the military and veteran community, and the barriers to seeking help in this population, King’s research led to NHS England (NHSE) committing to developing services dedicated to veteran mental health with an annual increase in funding for these services.
In 2017, NHSE launched the Transition, Intervention, Liaison Service (TILS). It supports military personnel through their discharge from military service and into their life as a veteran, linking the Ministry of Defence, NHS and community-based care to reduce the barriers to help-seeking. Ongoing research from King’s which has highlighted the mental health, social and welfare needs of the veteran population and their families has continued to influence and inform the development and funding of NHS veterans mental health and wellbeing services into the Op Courage services in 2023, which combine mental health, addictions, welfare, employment, housing and family support.
King’s research also highlighted a need for the service to focus on a specific area of concern – the increased rate of violent offending in those exposed to combat, and the suggested key targets for intervention – mental health and substance misuse. Research from King’s which highlighted the needs of veterans in the Criminal Justice System (CJS) influenced the development of a national network of community-based support services for veterans who come into contact with the CJS, Op Nova services, to link in with Op Courage services to ensure appropriate and timely mental health and alcohol and substance misuse support can be provided.
The importance of supporting military families
King’s conducted the first systematic research on the impact of service on military families in the UK. They studied a series of combined effects such as mental health problems, alcohol misuse and absence on spouses, partners and children’s mental health and wellbeing.
An old assumption about frequent deployment of a parent, usually the father, was that it caused military families to have “problem children”, or those identified as having special educational needs. However, King’s research proved that difficulties in children was actually linked to serious illness or injury of service personnel as the causal factor for issues such as poor mental health and relationship pressures in the families.
This work was used to underpin part of a 2019 independent review by the Secretary of State for Defence on the diverse needs of service families and the current support offer. In particular, it highlighted King’s recommendation to promote better mental health and wellbeing for the whole military family.
Families are important but are often forgotten in research, policy and practice. Our research has helped raise the profile of families to ensure their needs are recognised and appropriate services and support provided.
Professor Nicola Fear, Director of KCMHR
Informing high level policy on military mental health
King’s research has been extensively used to inform Government policy on the mental health and wellbeing of serving and ex-serving personnel and their families.
In 2014-15, the House of Commons Defence Select Committee scrutinised the way that Government strategies uphold the military covenant in relation to those injured, mentally or physically, as a result of military service. The resulting report was significantly informed by King’s research into the long-term mental health trajectories of military personnel.
KCMHR research was pivotal in the decision not to increase deployment length in Iraq and Afghanistan, showed that so called “Medical Counter Measures” used to protect the Armed Forces from chemical and biological weapons were not associated with medium or long term side effects, and played a major part in changing the way in which the Forces manage operational stress disorders.
Moreover, a key document which has set the scene for Government policy on mental health and wellbeing made extensive use of King’s cohort study to support it and was recently accessed for a rapid investigation into how COVID-19 has affected military veterans. The Government’s Defence People Mental Health and Wellbeing Strategy 2017-2022 is underpinned by 31 peer-reviewed academic papers and 27 of those were produced by KCMHR. This strategy remains the most trusted source of data on health and wellbeing of veterans of the conflicts in Iraq and Afghanistan.
Professor Simon Wessely sat on the first Veterans’ Board which was formed in 2020 to oversee the provision of services to military personnel and veterans, and the health and wellbeing of military families. Professor Nicola Fear sits on the Academic Advisory Board for the Office for Veterans’ Affairs.
Recent developments
The King’s military cohort study has now completed its fourth wave of data collection (2022-2023) assessing the health and wellbeing of serving and ex-serving personnel who served during the Iraq and Afghanistan era of conflict.
Phase 4 of the cohort study retains harmonised measures across phases to compare mental health and alcohol misuse outcomes. The latest phase also includes new measures assessing areas such as complex-PTSD, gambling, illicit drug use and loneliness so that the cohort can continue to report on relevant issues affecting health and wellbeing in this group.
Main findings from this phase will be launched late 2024.
Twenty years on, the KCMHR cohort study remains the key longitudinal source of data informing the UK Government and voluntary sector policies and service provision along with leading the way in academic research.
In this story
Professor of Epidemiology
Regius Professor of Psychiatry
Reader in Epidemiology
Senior Research Fellow
Post-doctoral Researcher
Clinical Reader
Professor of Public Health Medicine
Professor of Defence Mental Health