Title: Meeting the needs of women veterans in mental health services: Co-designing guidance for healthcare professionals
Funder: Department of Health and Social Care

Abstract: This project aims to identify the mental health support needs of women veterans, and to provide guidance and recommendations for mental healthcare professionals (MCHPs) to enhance NHS veteran-specific mental health support for women. Historically, women have been a significant minority in the UK Armed Forces, however the proportion of female ex-service personnel ( veterans ) in the UK is projected to increase from 11% to 13% between 2020-20281. Of concern are figures suggesting that a quarter of UK female veterans experience mental health problems, in comparison to a fifth of male veterans2 and non-military women3. Despite this, NHS veteran mental health services have been developed over the past 4 years without considering or prioritising women s specific needs. The potential impact of this is reduced engagement, with women making up just 5-6% of those accessing these services4,5, and the poorer mental health outcomes outlined above. Limited UK research has been carried out looking at the mental health needs and experiences of women veterans. US research suggests that women feel uncomfortable in male-dominated veteran healthcare environments, and would like access to treatment that is sensitive to their specific needs. An experts-by-experience (EBE) group of women veterans with lived experience of mental health problems was established at the Anglia Ruskin University, Veterans and Families Institute for Military Social Research, and expressed that NHS veteran-specific mental health services had not been designed to meet women s needs, resulting in poor experiences for women. We will carry out an 18-month project, in collaboration with NHS Veteran s Transition, Intervention and Liaison Service and Forward Assist, a charity which provides gender-specific mental health services for women veterans via their Salute Her programme. The EBE group have agreed to reform as a PPI Co-Design group to work in collaboration with the research team throughout the project. This project will use an experience-based co-design approach, consisting of three work packages (WP) over 18 months. During WP1, 10 focus groups will be conducted with women veterans (help-seeking and non-help-seeking) and MHCPs, to provide an in-depth qualitative exploration of the mental health support needs and experiences of women veterans. WP2 will utilise the focus group findings to inform the development of new guidance in collaboration with the PPI Co-Design Group. This guidance will include practical suggestions for implementing changes and supporting women veterans. WP3 will provide a preliminary evaluation of this guidance, conducted with MHCPs, to assess utility and usability. Findings will be presented at a Launch Event for academics, policymakers, practitioners and female veterans. Further funding will then be sought at the end of the 18 month period, to carry out a full 2 year evaluation of the guidance and recommendations for MHCPs in NHS veteran-specific mental health services. The short-term impacts of this research will provide vital original contribution to the understanding of women veterans support needs in the UK. Through ongoing partnership between researchers and women veterans the long-term impact we seek is improvements to service delivery, and increased engagement with NHS veteran-specific services and mental health outcomes for women veterans.

Lay abstract: This project aims to develop guidance for NHS mental healthcare professionals to meet the mental health support needs of women veterans. In order to do this, we will carry out an 18-month research project, working with: NHS veteran mental health services in the East of England; A charity called Forward Assist, which provides specific mental health services for women veterans. Women have always been a minority in the UK Armed Forces, however the proportion of ex-service women ( women veterans ) in the UK is set to rise from 11% to 13% by 2028. Almost a quarter (or 60,000) of UK women veterans experience mental health problems. This is higher than both male veterans and non-military women, of whom one fifth experience mental health problems. Despite this, NHS Veteran Mental Health Services have been developed without considering women s specific needs. The proportion of women accessing NHS Veteran Mental Health Services is half of what might be expected (5-6%), based on the proportion of women in the Armed Forces (11%). By not accessing specialist veteran services, women may not receive the NHS priority treatment available to veterans with mental health conditions that occurred as a result of their service. Waiting longer for treatment, and not accessing support tailored specifically for veterans, could lead to poorer mental health outcomes in women. An experts-by-experience (EBE) group of women veterans with experience of mental health problems was established at the Veterans and Families Institute at Anglia Ruskin University, consisting of 6 women from diverse military and socio-economic backgrounds. This group expressed that NHS veteran specialist services had not been designed to meet women s needs, resulting in poor experiences for women. This group will work in partnership with the research team throughout the project as our Co-Design Group. During the project we will speak with 48 women veterans (including those who have and have not used mental health services), in 8 focus groups (6 participants per group) to better understand the mental health support needs, experiences and expectations of women veterans. We will also speak to 12 mental healthcare professionals (6 participants in 2 focus groups), to better understand the challenges experienced in providing this support. Findings from the group discussions will be used to inform the development of new guidance in partnership with the Co-Design Group. This guidance will include practical suggestions for implementing changes and supporting women veterans. This guidance will then be evaluated using a survey with mental healthcare professionals to determine how useful the guidance is. To maximise impact, findings of this research will be communicated to a range of audiences, including women veterans, policy makers, and health and social care service providers at a launch event utilising the research team s extensive networks.

Research activity codes: 7.1 INDIVIDUAL CARE NEEDS;8.2 HEALTH AND WELFARE ECONOMICS
Health categories: MENTAL HEALTH