A Theory of Change in Support of UK Military Veterans with Lived Experience of Military Sexual Trauma

Military service is often associated with sacrifice, loyalty, and courage. Yet for many who have served, the period of military life has also been marked by deeply traumatic experiences, not only in combat but within the very institution meant to protect them. Military Sexual Trauma (MST) has emerged as a profoundly damaging reality that affects a significant number of veterans. While the United States has led much of the research and policy development in this area, the United Kingdom is only beginning to grapple with the depth of the problem and the specific needs of veterans who carry the scars of sexual assault or harassment experienced during their service. Veterans with lived experience of MST face a particularly complex set of challenges. The trauma is not only personal but also institutional, as it often involves betrayal by comrades, leaders, or the organisation itself. For these survivors, the transition to civilian life can be significantly more difficult, compounded by shame, stigma, mistrust, and an absence of dedicated services. To address these challenges, it is necessary to build a coherent and holistic framework of support that is informed by a clear theory of change. A theory of change provides a roadmap for understanding how interventions can lead to meaningful outcomes. It articulates the assumptions underpinning support strategies, sets out the processes through which change can occur, and envisions the long-term transformation for which services should strive. This article sets out such a theory of change for UK veterans who have lived experience of MST. It begins by contextualising the problem, exploring the scale and nature of MST and its impact on individuals. It then examines the theoretical frameworks that inform approaches to trauma and veteran support. Building on this foundation, the article develops a theory of change tailored to the UK context, outlining the vision, processes, and anticipated outcomes of interventions. Finally, it reflects critically on the strengths, challenges, and implications of adopting such a framework. Military Sexual Trauma is a term that encompasses sexual assault, harassment, and abusive behaviours experienced during military service. Although widely recognised in the United States, in the UK it has been less explicitly defined, though increasing public scrutiny is forcing the Ministry of Defence and other stakeholders to acknowledge its existence. Surveys and parliamentary inquiries in recent years have revealed that a substantial proportion of service personnel, particularly women, have faced unwanted sexual behaviours ranging from harassment to assault. Men too experience MST, though their voices are often less visible, silenced by stigma and entrenched gendered norms. The impact of MST is profound and multifaceted. Survivors often experience mental health conditions such as post-traumatic stress disorder, depression, anxiety, and dissociation. Many live with physical manifestations of trauma, such as chronic pain, headaches, and sleep disorders. Beyond individual health outcomes, the experience of MST damages trust in the institution of the military, leading to feelings of betrayal and alienation. Survivors may find themselves unable to rely on comrades or leadership structures, cutting them off from the very sources of support that military culture typically promotes and to which they are entitled. Transition to civilian life is already a complex process for many veterans, requiring an adjustment of identity, lifestyle, and support networks and for those with MST experiences, this transition can be severely hindered. They may feel excluded from veteran communities, especially where a culture of silence prevails. They may avoid accessing services out of fear that their disclosures will not be believed or will be mishandled. These challenges illustrate why MST survivors require tailored and sensitive support strategies that go beyond generic veteran programmes. Therefore, any effective theory of change must be rooted in an understanding of trauma and the contexts in which it occurs. Trauma-informed approaches provide a particularly important framework. Such approaches emphasise safety, trust, collaboration, empowerment, and respect for choice. They recognise that survivors of trauma often experience heightened vulnerability to re-traumatisation, and thus support systems must avoid replicating dynamics of power, silence, or control that echo the original trauma. When it comes to MST survivors, trauma-informed care has special significance. The military environment is highly hierarchical and often characterised by expectations of obedience and loyalty so when trauma occurs within this context, it can fundamentally disrupt a survivor’s ability to trust authority or engage with formal structures. Trauma-informed care acknowledges this reality and seeks to build relationships of safety and respect that allow survivors to regain agency. Similarly another important perspective is the intersectional lens. As experiences of MST do not occur in isolation from other aspects of identity such as gender, sexuality, ethnicity, or rank. Women, LGBTQ+ personnel, and individuals from minority backgrounds may face heightened vulnerability, while also encountering unique barriers to seeking help. An intersectional perspective ensures that services are not one-size-fits-all but instead respond to the diversity of survivors’ experiences. The veteran transition model also sheds light on the challenges MST survivors face, simply because, leaving the military involves not only a change in occupation but also a shift in identity and belonging. This process od adjustment is often complicated by a sense of betrayal and alienation and where other veterans may find camaraderie and pride in their service history, MST survivors may struggle with feelings of shame or exclusion. Therefore, recognising these dynamics is essential for any theory of change aimed at supporting this group. A theory of change is more than a service plan; it is a conceptual map of how desired outcomes can be achieved for UK veterans with lived experience of MST. The ultimate vision must be one in which survivors are able to live dignified, fulfilling lives marked by wellbeing, empowerment, and reintegration into society. However, achieving this vision requires significant input to address not only individual trauma but also institutional barriers, cultural attitudes, and systemic gaps in support. The starting point of this theory of change is the recognition of the problem: survivors of MST face unmet mental health needs, barriers to justice, and experiences of social exclusion. These challenges are exacerbated by the culture of stigma, silence, and denial that has historically characterised the military and veteran communities. The theory of change assumes that meaningful progress can only be made when services are survivor-centred, trauma-informed, and independent enough to build trust. The pathway to change begins with immediate interventions that focus on safety and validation and survivors must have spaces where they can disclose their experiences without fear of dismissal or reprisal. Running parallel to to this theory is the need for professionals in the NHS, veteran charities, and community organisations to access training so they can understand MST and respond appropriately. Such early interventions can reduce the risk of crisis, such as suicide or substance misuse, while laying the foundation for longer-term healing. In the medium term, survivors must have access to specialised, MST-specific support services. This includes counselling, therapy, and peer networks that are designed with survivor input. Services must be accessible and independent of the Ministry of Defence, to avoid retraumatisation and to build trust among survivors who feel betrayed by the institution. Peer support networks are particularly valuable, as they allow survivors to connect with others who share their experiences, breaking down isolation and fostering empowerment. At the same time, systemic advocacy is required to integrate MST recognition into broader veteran policy. This involves pressing for dedicated funding, independent reporting mechanisms, and the inclusion of MST in official veteran welfare strategies. Only through policy change can the structural environment be transformed to sustain long-term progress. The long-term outcomes envisioned by this theory of change include improved mental health and resilience among survivors, increased trust in support systems, reduced stigma, and broader cultural change within military and veteran communities. Survivors should not only heal from their experiences but also be empowered to participate fully in civilian life, whether through employment, community engagement, or family relationships. The ultimate aim is a society in which MST is acknowledged, addressed, and prevented, and where those affected are treated with dignity and respect. The strengths of this theory of change lie in its holistic and survivor-centred nature and by addressing the individual, social, and institutional dimensions of MST, it avoids the trap of focusing narrowly on mental health while neglecting systemic reform. It also places survivor voices at the centre, recognising that those with lived experience are best placed to shape services and ensure their relevance. However, significant challenges remain as stigma and silence continue to be major barriers. Many survivors remain reluctant to disclose their experiences, fearing disbelief, shame, or damage to their reputation. Therefore overcoming this requires sustained cultural change, not only within the military but in society at large as institutional resistance is another obstacle. The Ministry of Defence has historically been slow to acknowledge systemic problems of harassment and assault. While recent reforms have been announced, real change requires deep shifts in culture, leadership, and accountability. As I have pointed out on numerous occassions, without such change, survivors may continue to feel betrayed and excluded. Unlike the United States, where the Department of Veterans Affairs provides substantial infrastructure for MST survivors, the UK system relies heavily on underfunded charities and fragmented services so developing comprehensive MST support will require political will and financial commitment. Finally, intersectional gaps remain a risk. Services must be designed to accommodate the diverse experiences of survivors. Male survivors, for example, often face unique barriers to disclosure due to gendered stigma. LGBTQ+ veterans may experience both sexual trauma and discrimination related to their identity so ensuring inclusivity is essential if services are to reach all those in need. In conclusion, Military Sexual Trauma is an under-recognised but profoundly damaging issue within the UK veteran community. Survivors carry not only the burden of individual trauma but also the weight of institutional betrayal, stigma, and social exclusion. To address these challenges, a clear and coherent theory of change is essential. The theory of change outlined in this essay envisions a future in which MST survivors are able to heal, find empowerment, and reintegrate into society with dignity. It begins with immediate steps to ensure safety and validation, progresses through the establishment of specialised support services and peer networks, and culminates in long-term cultural and policy change. While challenges remain, stigma, institutional resistance, limited resources, and the need for inclusivity, the framework provides a roadmap for progress. Ultimately, supporting veterans with lived experience of MST requires more than individual therapy or charity initiatives. It demands a systemic transformation of the ways in which the military, government, and society recognise and respond to trauma. It will only suceed if we embed trauma-informed, survivor-led principles into every level of service provision and policy development. I hope that one day we can create an environment in which veterans are not defined by their trauma but empowered to build lives of dignity and hope.

Tony Wright CEO Forward Assist