New report explores combat-injured veterans' perceptions of their physical and mental healthcare

Blog written by Aubrey Sutherland, Anna Verey, Dr Daniel Dyball, Dr Danielle Lamb, and Professor Sharon Stevelink

•       Nearly 550 ex-Service personnel, including almost 400 seriously injured in Afghanistan, contributed survey data, and 28 took part in in-depth interviews

•       Participants consistently described military physical healthcare as excellent, but reported more mixed experiences with long-term pain management, civilian prosthetics services, and mental healthcare

•       Personnel injured without limb loss described feeling less comprehensively assessed and treated than those with limb loss, in some cases leading to the worsening of their conditions, and their use of tribunals to receive the compensation they felt they were warranted

A new report from the King's Centre for Military Health Research (KCMHR) examines how UK Armed Forces personnel who were seriously injured on deployment to Afghanistan experienced their physical and mental healthcare, both during service and after their transition to civilian life.

The report draws on data from the ADVANCE-INVEST study, which is funded by Forces in Mind Trust and supported in part by the ADVANCE Charity¹. It combines questionnaire data from 547 ADVANCE participants who had left the Armed Forces with 28 in-depth interviews. Of those interviewed, 12 had been injured with limb loss, 12 had been injured without limb loss, and 4 were medically discharged members of the uninjured comparison group.

The findings fall into four areas.

Physical healthcare. Participants praised the care they received from the point of injury, through field hospitals, UK military wards, and Defence Medical Rehabilitation Centres (DMRCs). However, some of those injured without limb loss felt their injuries had not been fully assessed at the outset and some described being met with skepticism when they reported ongoing symptoms, and believed that delays in diagnosis had left them with chronic pain.

Prosthetics and mobility aid services. Those with limb loss described military prosthetics services as fast and effective. Civilian services were perceived to be more variable. NHS providers with a veteran-specific remit were often highly responsive, while others were slower, which could negatively affect participants' mobility, professional commitments, and family responsibilities.

Pain and pain management. Those injured with and without limb loss reported more pain than the uninjured comparison group, and employment rates fell as pain severity rose. Participants appreciated ample pain relief in the acute phase of military care. Some, however, described long-term opioid use that raised concerns in healthcare providers about misuse. By contrast, civilian approaches to pain relief were sometimes experienced as overly conservative. Participants who attended structured pain management programmes found them to be effective.

Mental healthcare. Experiences of military mental healthcare were mixed. Participants described brief or superficial early assessments, repeated changes of therapist which meant they had to retell their experiences, and rigid, stepwise treatment pathways. Some disengaged from mental health support service provision entirely as a result. Some participants felt that neurological and psychological injuries were less prioritised than visible, physical trauma. In civilian care, long wait times and poorly matched group settings were common complaints, although those who accessed specialist veteran services or long-term talking therapy generally found them valuable.

The findings come as the Armed Forces Covenant Legal Duty is being expanded through the Armed Forces Bill 2026. The expansion extends the Duty to all UK Government departments and devolved administrations, and broadens its scope to include social care, employment, and welfare benefits. With this in mind, the report sets out nine recommendations for healthcare providers, the MOD and DMRC, third sector organisations, and researchers. These include:

•       ensuring equity of healthcare pathways regardless of injury type

•       providing consistent referral to, and rapid responses from, civilian prosthetics services

•       promoting pain management programmes

•       strengthening mental healthcare provision within military systems and ensuring the continuity of mental healthcare as injured personnel move from DMRC into civilian systems

These findings go some way to explaining recent findings from the ADVANCE cohort that show those with less visible injuries, such as those without limb loss and those with traumatic brain injury, have worse mental health outcomes in the long term compared to uninjured personnel, whilst those injured with limb loss do not (https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2854877?widget=personalizedcontent&previousarticle=0).

In his foreword, Dr Neil Kitchiner, Director and Consultant Clinical Lead of Veterans' NHS Wales, wrote that the report “does not offer easy answers. What it offers is evidence, specific and actionable from those it concerns most directly.”

This report is dedicated to Professor Nicola T Fear CBE, former Director of KCMHR and senior author on this work. The ADVANCE-INVEST team is grateful for her guidance, mentorship, supervision and kindness, without which this research would not have been possible.

Ends

For more information, please contact [email protected]

Combat injured veterans' perceptions of their physical and mental healthcare: a short report from the ADVANCE-INVEST study (Verey, Burdett et al.) was published by King's College London.

¹ The ADVANCE study's key contributors are Headley Court Charity (principal funder); HM Treasury (LIBOR grant); Help for Heroes; Nuffield Trust for the Forces of the Crown; Forces in Mind Trust; Blesma, The Limbless Veterans; and the UK Ministry of Defence.

About Forces in Mind Trust (FiMT)

Forces in Mind Trust (FiMT) was founded in 2011 with a £35 million endowment from the National Lottery Community Fund to improve transition to civilian life for Service leavers and their families. Our mission is to enable successful and sustainable transition to civilian life. FiMT delivers this mission by funding high quality, credible research where there is an identified gap in relevant understanding, and by then exploiting the findings, FiMT aims to effect positive change. 

www.fim-trust.org |@FiMTrust

Authors

Anna Verey, Dr Howard Burdett, Dr Laura Palmer, Gp Capt Alex Bennett, Prof Paul Cullinan, Prof Christopher Boos, Prof Anthony Bull, Dr Harriet Kemp, Prof Nicola T Fear CBE