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British veteran welfare and suicide: AOAV calls for improved veteran suicide risk research and support in the UK

Executive Summary
Contrary to landmark reports, which claim that veteran suicide rates are comparable to the general population, AOAV cautions against complacency in this area. There are specific subgroups within the veteran community, such as young veterans and those with short service duration, who are at a greater risk of suicide and who require targeted support that currently seems missing. Methodological flaws in existing studies further complicate the narrative. Additionally, media coverage tends to sensationalise male veteran suicides, potentially influencing suicide rates.

In this report, AOAV recommends a reform in research methodology to provide a more accurate comparison of veterans’ experiences, particularly during the COVID-19 pandemic. Media editors should adhere to guidelines that minimise the risk of imitative suicides. Improved monitoring and recording of veteran suicides is imperative, as is the establishment of an annual engagement framework to verify veterans’ well-being. Additionally, the government should enhance support for dependents of deceased veterans, recognising their unique grief and potential mental health challenges. AOAV’s conclusions urge the UK government to acknowledge and address the complexities of veteran suicide through robust policy and support mechanisms.

  1. Context

The United Kingdom has been involved in over 80 military engagements across 47 countries since the conclusion of the Second World War[1]. This has included covert operations, colonial interferences, and overt interventions. A direct consequence of this has been a considerable veteran population of just over 1.85 million in the UK in 2021[2]. It has been estimated by the Office for National Statistics that around 60% of veterans were aged 65 and over, making up 5% of household residents aged over 16 and over[3].

The UK government has produced data that shows that 79% of working-age veterans are employed, 92% have a qualification, and 76% of veterans have either bought their own home or have a mortgage[4]. With these figures, the government has emphasised that they are ‘no different’ than that of ordinary civilians. However, challenges faced by veterans seem inherently different. Exposure to the brutality of war can generate a multitude of long-term mental health issues, particularly in an environment or community that tends to have a stigmatised view of mental health.

It is, therefore, unsurprising that some veterans return home from overseas combat and face elevated risks of offending, alcoholism, homelessness, and overall poor mental well-being. The root causes of these challenges are diverse. They range from physical injuries to mental health conditions like post-traumatic stress disorder (PTSD), of which 7.4%[5] of veterans suffer, to the struggles of transitioning into civilian life.

For some, this led them to take their own lives. Research undertaken by the Ministry of Defence and NHS England reveals that in the UK 0.2% of veterans took their lives between 1996 and 2018[6].

  1. British veteran suicide statistics and trends

Suicide rate
Through online searches, AOAV’s own research has found 80 veteran suicides as reported by British local and national media in the last 21 years[7]. Of note, the highest annual suicide rate as reported by the press (28.75%) occurred in the year 2021. which coincides with the COVID-19 pandemic. The reason for this spike is unclear. It could, of course, just be heightened media interest in veteran suicide; it could be the isolation of the pandemic triggered lingering health issues; or it could be that a generation of ex-soldiers, traumatised in Iraq or Afghanistan, hit early middle age and were unable to live with the ghosts of the past.

In 2023, the National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH) published a report titled ‘Suicide after leaving the UK Armed Forces’ between the years 1996-2018[8]. The main finding of the report was that the suicide risk in personnel leaving the UKAF was not high but there are “important differences according to age, with higher risk in young men and women”. Factors associated with reduced risk included being married, a higher rank, and deployment on combat operations. However, that period did not include the spike in reported suicides in 2021, so it is unclear if the extension of the period from 1996 – 2018 to 2021 would change some of the conclusions, given the reported high levels of suicide that year.

Method of suicide
The most common method used by veterans taking their own life was hanging (26.25%). This accords with the finding in the 2021 census that the most common method of suicide in England and Wales for both males and females continues to be hanging, strangulation, and suffocation[9]. This was attributed to the high fatality of hanging in a Korean National Investigations of Suicide Victims study[10].

Age
Data accumulated by AOAV shows that the average age of veterans who took their lives was 31.94. This is in line with research conducted by the University of Manchester on veteran suicide[11]. The study demonstrated that younger veterans and those who left after a short career were more at risk, whilst those who served in the military for longer periods and served on operational tours were associated with reduced suicide risk. Furthermore, the mode was 24. This aligns with the finding in the study that suicide rates were 2-4 times higher for veterans under the age of 25 when compared with the general population of the same age group.

Gender
Only 5% of veteran suicides were recorded to be women. Though this could be linked to the reality that most members of the armed forces are men, it is also due to a worldwide phenomenon whereby men are more likely to take their lives. This is for a variety of reasons. A study of more than 4,000 hospital patients who had engaged in self-harm found that men had higher levels of suicidal intent than women[12]. Furthermore, male suicide methods are often more violent. This makes them more likely to be completed before there can be any intervention.

Location of deployment
The main locations of deployment for veterans in the last 21 years were Afghanistan (43.75%) and Iraq (36.25%). This corresponds with a recent finding that there has been a cluster of veterans who served under the auspices of Operation Herrick who have taken their lives recently[13]. These deaths can be traced to a particular unit that served during the “bloodiest time” of the war[14].

  1. British veteran suicide and the COVID-19 pandemic

Research has shown that the pandemic led to an exacerbation of risk factors for suicide. These include isolation, disruption to mental health support, loss of social interaction, bereavement, and trauma, inter alia. It would be supposed that there would be an increase in British veteran suicide given that these were risk factors contributing to suicide rates before the pandemic. Nevertheless, the literature stresses that supposition is not to be substituted for evidence.

A study conducted by Kings College London and the BMJ on UK veterans’ mental health before and during the COVID-19 pandemic[15] has concluded that “veterans experienced the pandemic in similar ways to the general population and in some cases may have responded in resilient ways”[16]. The study noted that there was no increase in levels of common mental disorders, veterans reported significant reductions in levels of hazardous drinking, and a total of 27.4% reported feelings of loneliness. This is a lower level of loneliness compared with a UK general population sample from the COVID-19 Social Study (39%)[17]. These findings are to be caveated with the fact that there remains a group of veterans who may need mental health and alcohol treatment services.

In a study published by the BMJ[18], it was noted that there was concern by the media about rises in suicide rates since the start of the COVID-19 pandemic, despite evidence that suicides did not in fact increase in the first year of the pandemic. They found that over a third of articles (39.2%) and headlines (41.4%) claimed or predicted a rise in suicide, often attributed to feelings of entrapment or poor mental health. Almost a third of the reports were rated as being of a negative quality (31.2%), and at least half included no signposting to help and support. This style of reporting piqued during times of greater social distancing restrictions. Crucially, this can have a profound influence on the health-related behaviour of the public, particularly suicide risk. The fuelling of harmful myths and misinformation can contribute to imitative behaviours.

  • The interrelationship between media reporting and suicide

There is a direct corollary between media reporting on suicide and rates of suicide. This has been coined the ‘Werther effect’ and is a well-documented occurrence. A famous example is the 10% increase in suicides in the US after the sensational media coverage surrounding the death of comedian Robin Williams[19]. This has been linked to the suicide reporting style adopted by reporters at the time, often deviating from the internationally applicable WHO guidelines. Specifically, giving suicide-related articles prominent placement (such as on the front page), high duration, and describing the method[20]. This is a particular problem regarding suicides by men, and members of the military, as they tend to be over-reported[21].

A study on the relationship between US veteran suicides and media reporting was undertaken in 2011[22]. It found that from the sample of newspapers, “most of the newspaper articles had many deviations from the recommendations”[23]. The most common deviation was the use of the word ‘suicide’ in the article’s headline, and inappropriate language such as ‘committed suicide’. In particular, military suicide articles referred to ineffective mental health support as a driving factor of the suicide. This is potentially dangerous reporting as it can imply that seeking support for depression and suicidal thoughts can lead to suicide. Moreover, it can exacerbate pre-existing military stigmas regarding mental health treatment.

AOAV’s research on methods used by reporters to document veteran suicides suggests that there may have been irresponsible media reporting styles during the pandemic. First, 47.5% of newspaper articles outlined the suicide method. This trend slowed in recent years, perhaps reflecting the implementation of the Samaritans’ media guidelines. Second, 10% of newspaper articles used the phrase ‘committed suicide’ to describe the veteran’s death. Third, 55% of newspaper articles did not include links to help such as the Samaritans suicide helpline. These are all direct contraventions of the Samaritans’ media guidelines. Though the inclusion of links to help has increased in recent years, there were still articles that fell below the standard set by the guidelines. This can have the dangerous effect of suicide imitation.

  • Recommendations

Methodology reform
Several reports have been commissioned on the topic of veteran suicide. The first is a landmark report undertaken by the BMJ and KCL on UK veterans’ mental health before and during the COVID-19 pandemic[24]. The report concluded that veterans experienced the pandemic in similar ways to the general population and, in some cases, may have responded in resilient ways. There were findings of stable levels of common mental health disorders and a reduction in alcohol use. However, AOAV calls for scrutiny of the report’s methodology when arriving at this conclusion. The report used the general population as the basis of comparison. The general population does not have the same characteristics as veterans. Due to military screening processes, veterans tend to be of a healthy weight, without physical and neurological diseases and have developed ways to strengthen their resilience. Thus, it may be that a comparison with veterans in other countries, such as the United States, may have been a more informative basis for comparison when determining the effects of the COVID-19 pandemic on veterans. Moreover, the online survey only took place between June and September 2020. The pandemic only began in March 2020, and therefore this was too short a period to truly assess the effects of the pandemic on veterans. For example, AOAV research shows that there was a surge in suicides in 2021. If the online survey were extended beyond 2020, greater clarity on whether this surge was due to the pandemic may be given.

A second landmark report is the NCISH study titled ‘Suicide after leaving the UK Armed Forces’ between the years 1996-2018[25]. The report was published in August 2023. The main finding of the report was that “the overall risk of suicide in veterans is not high but that young men and women leaving the UKAF are at higher risk, especially if they have had a short length of service”. However, the report did not include data from the pandemic years, 2020-2022. The pandemic years may have exacerbated risk factors for veteran suicide such as PTSD and these effects may linger until the present day. For a study that claims to represent a present-day assessment of British veteran suicide rates, it is a considerable limitation that this period was not included in the study’s dataset.

Media reporting
A key issue affecting veteran suicide is the inappropriate presentation of suicides in the media. Certain types of media depictions can lead to imitational suicidal behaviour among vulnerable people. To address this, the Samaritans have developed media guidelines for reporters to follow[26]. They offer practical advice on how to reduce the risk of media coverage negatively impacting people who may be vulnerable. For example, the guidelines stipulate that dramatic headlines, methods of suicide, and sensational pictures, should be avoided. Rather, references to suicide being preventable should be included along with sources of support. The guidelines outline that some forms of reporting can help save lives. Coverage describing a person or character seeking help and coming through a difficult time can serve as a powerful testimony to others that this is possible and can have a protective influence over audiences. This is called the Papageno effect and has been linked to falls in suicide rates.

A study on suicide coverage in 968 local and national US newspapers illustrates that media guidelines are not consistently followed[27]. On the positive side, the study found that only 2% of the stories included inappropriate imagery. However, on the negative, it found that 56% detailed the suicide method, 58% provided the location, and they rarely provided information about warning signs and risk factors. The study concluded that there is a need for sustained dialogue with the media about suicide reporting. This is because journalists are generally uninformed that imitation suicide is a potential consequence of certain suicide reporting. Thus, active (via education) and targeted (to reporters) dissemination is likely required for media guidelines to measurably impact reporting. Whilst the Samaritans have developed media guidelines for reporters to follow, it is the responsibility of the state to create this dialogue with the media, not the charity sector. This is because the charity sector neither has the means, financial or otherwise, nor the influence, to enact real change in this context. Therefore, AOAV recommends that the British government consider implementing the guidelines using statutory instruments, regulations, or at least developing public awareness campaigns.

Though AOAV hypothesises that an increase in media reporting during the years 2020-2022 may have contributed to veteran suicide rates, there may have also been other factors at stake. Johnny Mercer has held the role of Minister for Veterans Affairs on and off again from 2019 to the present. During these years, he has drawn attention to the lives of veterans and their struggles. It may be that this increased media attention on veteran suicides is not due to a rise in suicides, and thus contributing to a ‘feedback loop’, but rather a response to Mercer’s campaign to raise awareness. Indeed, the spike in veteran suicides corresponds with his time in office. Therefore, the 2023 NCISH report needs to extend its dataset to include the COVID-19 pandemic to see whether there was indeed an increase in suicides during this time, or whether there was just increased media reporting.

Governmental monitoring
Johnny Mercer, the Minister of State for Veterans’ Affairs, stated in March 2020 that veteran suicide “requires everyone to play a role – to speak out, to reach out, to look after yourselves and each other”[28]. To this, Stephen Morgan, the Shadow Defence and Communities Minister, replied that the scale of the problem is not fully known as coroners in the UK do not record veterans’ suicides. This therefore makes it difficult to provide support and stage interventions. Thus, AOAV suggests that for the government’s ‘role’ to be fulfilled, national guidelines should be developed to ensure that coroners record veteran suicides. This can ensure that the data regarding veteran suicides is accurate and that hotspots for veteran suicides or military friends of the deceased can be monitored.

A lack of governmental monitoring is a particular problem for younger veterans. As aforementioned, younger veterans and those who served for a short period are more likely to take their lives. A recent study has theorised this to be for a multitude of reasons[29]. First, older veterans are more likely to be officers and rank highly which is associated with better education and socioeconomic status. Moreover, other protective factors such as being married and having completed training tend to be absent for younger veterans. This demonstrates the importance of social support and integration. Lastly, younger veterans are less likely to seek help from NHS mental health services. The study has linked this to stigma or a perception that civilians may not understand the issues they are facing or have faced. Therefore, it is evident that an annual engagement regime undertaken by the government will help address this problem. This can be complemented with campaigns to reduce stigma.

Support for dependants
A veteran taking their life causes tremendous grief for their loved ones and family. The government needs to note that support should be extended to them too. Research has shown that loss survivors find administrative documents and processes to be challenging, have difficulty navigating available grief and support resources, and believe that suicide deaths are treated differently from other military deaths[30]. To remedy this, AOAV recommends that the government try and change how the military perceives suicide. This will aid loss survivors who are finding it difficult to grieve their death due to stigma. In the US, the military now has policies and procedures that describe memorial and funeral offerings available to deceased military personnel, as well as awards that they are eligible to receive posthumously. This is an important case study on how the government can change how the British military treats suicide deaths.

Mental health support must also be delivered to dependants. There have been instances of family members of the deceased developing PTSD[31] and, in rare cases, taking their own lives. The army does not extend PTSD counselling to family members, and some have faced up to a 14-week wait before they can get help for their condition on the NHS[32]. This general feeling among those left behind has led to the creation of support groups, such as ‘For The Fallen’[33], which are intended to help families who have lost a loved one through military suicide. However, again, support should not be left to the charity sector. The government has the resources to support dependants and can do so through annual engagement and accessible counselling.

  • Conclusion

In conclusion, AOAV has identified multiple deficiencies in the UK’s veteran framework. Firstly, the conclusions made by some landmark veteran mental health reports should be viewed through a cautionary lens. This is due to the risk that the high suicide rate for vulnerable veteran groups such as those under 25, and deployed for short periods, will go unaddressed. The reports also suffer from methodological shortcomings which AOAV has recommended be remedied. Second, media reporting of veteran suicide has been unregulated by the state for too long. Third, veteran mental health and suicide is largely unmonitored by the government. There is no annual engagement framework like that in the US and Canada[34], and no guidance for coroners to follow when reporting a veteran suicide. Lastly, the government must develop support frameworks for dependants. These are all recommendations that are within the state’s mandate and can have a real effect on the complex issue of veteran suicide.

If any of the issues in this article caused distress, please consider speaking to the Samaritans. You can call them for free on 116 123, email them at jo@samaritans.org, or visit samaritans.org to find your nearest branch.


[1] https://www.declassifieduk.org/the-uks-83-military-interventions-around-the-world-since-1945/#:~:text=Some%20of%20the%20UK%27s%20most,a%20US%20military%20base%20in

[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10131745/https://www.ons.gov.uk/peoplepopulationandcommunity/armedforcescommunity/articles/characteristicsofukarmedforcesveteransenglandandwalescensus2021/census2021#:~:text=Of%20the%20total%20UK%20armed,Service%20from%201939%20to%201960.

[3] https://www.gov.uk/government/statistics/ annual-population-survey-uk-armed-forces- veterans-residing-in-great-britain-2017

[4] https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/774937/20190128_-_APS_2017_Statistical_Bulletin_-_OS.pdf

[5] https://combatstress.org.uk/new-research-reveals-higher-rate-ptsd-among-veterans

[6] https://www.gov.uk/government/news/new-figures-provide-latest-data-on-veterans-suicide

[7] N.B. This is a small dataset. AOAV does not claim to be representing all veteran suicides in the last 21 years.

[8] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10409259/

[9] https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/suicidesintheunitedkingdom/2020registrations#suicide-methods

[10] https://www.frontiersin.org/articles/10.3389/fpsyt.2021.651327/full

[11] https://www.manchester.ac.uk/discover/news/new-figures-provide-latest-data-on-veterans-suicide/

[12] https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/value-of-measuring-suicidal-intent-in-the-assessment-of-people-attending-hospital-following-selfpoisoning-or-selfinjury/5998207CACFA9665CA9E07F98FA2960C

[13] https://www.independent.co.uk/news/uk/home-news/british-veteran-soldiers-afghanistan-suicides-deaths-a9367856.html

[14] https://www.independent.co.uk/news/uk/home-news/british-veteran-soldiers-afghanistan-suicides-deaths-a9367856.html

[15] https://bmjopen.bmj.com/content/11/8/e049815.full

[16] https://bmjopen.bmj.com/content/11/8/e049815.full

[17] Bu F, Steptoe A, Fancourt D. Who is lonely in lockdown? cross- cohort analyses of predictors of loneliness before and during the COVID-19 pandemic. Public Health 2020;186:31–4.

[18] https://bmjopen.bmj.com/content/bmjopen/13/2/e065456.full.pdf

[19] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6508639/

[20] https://www-tandfonline-com.ezproxy.is.ed.ac.uk/doi/pdf/10.1080/13811118.2011.615692?needAccess=true

[21] Weimann, G., & Fishman, G. (1995). Reconstructing suicide: Reporting suicide in the Israeli press. Journal- ism and Mass Communication Quarterly, 72, 551–558.

[22] https://www-tandfonline-com.ezproxy.is.ed.ac.uk/doi/pdf/10.1080/13811118.2011.615692?needAccess=true

[23] Ibid.

[24] https://bmjopen.bmj.com/content/bmjopen/11/8/e049815.full.pdf

[25] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10409259/

[26] https://www.samaritans.org/about-samaritans/media-guidelines/media-guidelines-reporting-suicide/

[27] https://www.researchgate.net/publication/47632955_Suicide_Coverage_in_US_Newspapers_Following_the_Publication_of_the_Media_Guidelines

[28] https://www.parliament.uk/business/news/2020/march/statement-on-veterans-mental-health/

[29] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10409259/

[30] https://discovered.ed.ac.uk/permalink/44UOE_INST/7g3mt6/alma9924040922802466

[31] https://www.mirror.co.uk/news/uk-news/mum-soldier-who-took-life-22597987

[32] https://www.mirror.co.uk/news/uk-news/mum-soldier-who-took-life-22597987

[33] https://nspa.org.uk/member/for-the-fallen/

[34] https://combatstress.org.uk/investigation-reveals-lack-data-suicides-veterans