https://orcid.org/0000-0002-1354-0343
ABSTRACT
Law has been recognised as a significant social determinant of health, however, micro-level legal advice interventions are underexplored. The dearth of research concerning the experience of British veterans highlights the need for uniquely tailored support services. This need is emphasised by the pervasiveness of mental health issues amongst this population. We investigate the feasibility of remotely delivered legal advice as a social intervention for supporting the mental wellbeing of UK veterans. This is based on the Warwick-Edinburgh Mental Wellbeing Scale results from 67 participants, who completed a pre and post legal intervention survey. Average WEMWBS results were higher post-intervention, particularly in participants with pre-identified mental health issues. The difference in overall scores pre and post intervention is statistically significant (p = 0.034). A correlation matrix identifies two variables, with one contributing to 59% variance (LV2). These are identified as “Affective” (LV2), and “Cognitive” (LV1). The difference between LV2 results pre and post intervention was significant (p = 0.016). Findings highlight the importance of individualised interventions for veterans. Free, remotely delivered, tailored legal advice and support shows feasibility as a social intervention due to its ability to encourage emotional disclosure, something which the veteran population can struggle with.
Introduction
Recent statistics from the Ministry of Defence (Citation2022, p. 1) show that in 2021/22, “1 in 8 (12.5%) UK armed forces personnel were seen by military healthcare services for a mental health related reason”. Among veterans, the prevalence of mental health disorders was as high as 38% (Finnegan and Randles Citation2022). While there is a growing literature on the value of legal advice as an intervention, it is still under researched.
Following Blodgett et al.’s (Citation2022) systematic review of mental wellbeing interventions, social interventions, (distinguished as person-centred support and advice) had a “medium to strong” impact on people’s mental wellbeing. The observed impact of these social interventions surpassed that of some psychological interventions (specifically, psychoeducation and mindfulness), physical interventions (promoting physical activity and health), and peer-support interventions. Blodgett et al. (Citation2022) called for more research on specific intervention topics and modes of delivery to enhance our understanding of the effectiveness of certain interventions in promoting mental wellbeing. In turn, this type of research can provide valuable insights that can inform the development of more effective policies and practices to improve people’s mental health.
An association has been found between advice service interventions and mental health and wellbeing (Sefton Citation2010; Wintersteiger Citation2015; Young and Bates Citation2022). Legal problems in general can exacerbate mental health challenges due to increased stress and/or worry (Sefton Citation2010). Sefton (Citation2010) argued that individuals experiencing mental health issues are more likely to experience a range of social welfare law and civil law problems. Furthermore, it has been shown that when welfare advice is given in healthcare environments, individuals tend to experience improved wellbeing, which in turn reduces the demand for healthcare services (Parkinson and Buttrick Citation2015). This may also be true when welfare advice is given outside of a healthcare environment. In a systematic review investigating the link between advice services and health and wellbeing, Young and Bates (Citation2022) found that receiving advice was associated with improved mental health and wellbeing. However, they also noted that the “association between advice services and health outcomes is complex and not well evidenced” (Young and Bates Citation2022, p. 1714).
This paper contributes to three distinct strands of literature. First, it contributes to the body of work on veterans’ mental health through the lens of positive mental health. This paper is also adding to the growing literature on the role of legal advice as a social intervention. Finally, the paper contributes to the large literature on mental wellbeing interventions. It is noteworthy to mention that within the discourse, the terms mental health, mental wellbeing, and general wellbeing refer to similar concepts. The mental health definition we have chosen is the WHO’s (Citation2022) interpretation which is as follows: “Mental health is a state of mental wellbeing that enables people to cope with the stresses of life”. In addition, the WHO’s definition resonates with the position that it is essential to view mental health not only by the presence or absence of psychopathology but also by the flourishing of wellbeing (Aruta et al. Citation2022, p. 2; Horwood et al. Citation2023, p. 1; Keyes Citation2002; Keyes and Lopez Citation2002). Moreover, extant research has found that higher levels of mental wellbeing (flourishing) are protective against the incidence of Common Mental Disorders (CMDs) (Santini et al. Citation2022; Schotanus-Dijkstra et al. Citation2017). Conversely, lower levels of mental wellbeing (languishing) have been associated with an increased risk of developing CMDs (Grant et al. Citation2013). Notably, the Warwick Edinburgh Mental Wellbeing Scale (WEMWBS) used to evaluate improvements in mental wellbeing in this study, has the ability to capture both the cognitive (psychological) and affective (emotional) dimensions of mental wellbeing. In addition, studies to date show a significant negative correlation between WEMWBS and widely respected measures of mental illness such as General Health Questionnaire-12 (GHQ-12) (Shah et al. Citation2021). In other words, individuals reporting higher mental wellbeing scores have been found to have lower scores of psychiatric morbidity. This has implication for veteran participants in this study who notably had the opportunity to disclose mental health issues such as PTSD and depression.
This research aims to investigate the impact of free, remotely delivered, tailored legal advice and support on veterans’ mental wellbeing. The objectives were to (1) evaluate if legal advice positively impacted the mental wellbeing of veterans pre and post intervention; and (2) identify trends regarding veterans’ demographic data and self-reported mental health and substance abuse data.
Sampling and study participants
The Veterans Legal Link (VLL) project is an access to justice project that uniquely provides free legal advice and case work, and specialist support services to veterans (any service leaver who served at least one day in the British armed forces) and their families. There are several organisations in the UK that provide veterans cursory or specific support for legal issues. One example is The Centre for Military Justice which provides legal advice for serious bullying, sexual harassment, gender-based violence, racial or other forms of discrimination. In contrast, VLL provides a full suite of free legal advice and case work and specialist support services to veterans and their families that is unparallelled (Guide to Pro bono and Other Free Advice in England and Wales, 2023). Moreover, over 40 veterans’ organisations use the VLL as a referral partner for legal advice. This includes The Royal British Legion, Project Nova, Help for Heroes, Blind Veterans UK, The Soldiers’, Sailors’, and Airmen’s Families Association (SSAFA) and Veterans NHS Wales. Furthermore, the project employs a fulltime non-practising solicitor and a case work manager to deliver legal advice and conduct casework remotely (including telephone, text messaging, email, online portal, letters, and so on) and also to signpost veterans to support services.
VLL provided legal advice, case work and or signposting on the following areas: Appeals (1%), Business Law (3%), Civil Law (15%), Complaints (4%), Criminal Law (6%), Employment & Employment Law (10%), Estates (4%), Family Law (37%), Housing (6%), Immigration (3%), Military Injury (13%), and Social Care (1%). The participants for this study were drawn from the service users of the project seeking legal advice and agreed to participate in the research. Participants had an average of 11 years military service, with 75% having served in the Army, 12% from the Navy and 13% from the RAF, and were made up of both male (82%) and female (18%) service leavers. In addition, we collected demographics on current employment status, self-reported substance abuse and mental health concerns/issues.
Methods
Data for this research was gathered from Veterans Legal Link’s casework database: Auxilium. This included demographic and service data, how clients were referred, area of law, and self-reported mental health or substance issues. Ethical approval was obtained from the Aberystwyth University Ethics Committee.
Auxilium was used to distribute the WEMWBS to veterans accessing the legal advice service. WEMWBS is a “user-friendly and psychometrically sound measure of mental wellbeing” (Peacock et al. Citation2019, p. 4), providing high levels of internal consistency and reliability against accepted criteria. It provides an approximately normal distribution with no floor to ceiling effects and is responsive to change, making it a suitable tool for monitoring mental wellbeing in population samples. This research is based on 67 results. Notably, WEMWBS recommends at least 30 clients to explore the impact of an intervention (Warwick Medical School, Citation2023).
A pre-intervention survey was distributed upon registration of clients accessing the legal advice service. A follow up, post survey was distributed upon resolution of the legal matter, or for more complex cases no sooner than two weeks following the initial survey in line with WEMWBS guidance. The time between completing the pre and post survey averaged at 122 days. Participants who did not complete both pre and post intervention surveys were excluded. Clients completed the 14-question survey upon referral, and again after accessing legal advice. Questions were related to positive aspects, relations, and functioning, and were collected using a Likert scale of 1–5, indicating “none of the time” to “all of the time” (Tennant et al. Citation2006). Scores were calculated to provide a singular, reflective value of someone’s mental wellbeing. This is shown in .
Figure 1. [Q8]Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS) © University of Warwick 2006.
![Figure 1. [Q8]Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS) © University of Warwick 2006.](/cms/asset/31fccf3d-1ae9-4755-9199-704da5720407/cijl_a_2351875_f0001_ob.jpg)
The survey results were evaluated using the evaluation tool provided by WEMWBS. The tool was used to analyse the following: mean and mean change, percentage of people with significant change, and if change is statistically significant. Further statistical tests were also conducted to evaluate the data. This included testing for latent variables within the WEMWBS survey and associations with additionally reported data provided by participants (mental health, substance abuse, etc.).
Findings
Following the receipt of legal advice and/or support intervention, the median WEMWBS score increased from 28 to 32, with standard deviation reducing from 10.8 to 9.3. This suggests a positive correlation between receiving legal advice/support, and an alleviation of mental wellbeing, as overall scores improved and were clustered closer to the mean.
Non-parametric testing was conducted which found the difference in scores (pre and post intervention) to be statistically significant, with a Wilcoxon Signed Rank test p-value = 0.034 against a 0.05 significance level.
Veterans who self-reported mental health issues before the intervention (n = 53) had a lower average WEMWBS score compared to those without mental health issues (n = 14), at 28 and 37 respectively. However, both scores remain lower than the general population average, at 50.1 for men, and 49.6 for women (NHS Citation2016), showing the importance of empirical research on mental wellbeing for this population. This factor of pre-existing mental health issues on the WEMWBS scores is considered statistically significant, with a Mann – Whitney U test p-value = 0.02.
For those without mental health issues, a Wilcoxon signed rank test found no statistically significant difference between median WEMWBS scores pre and post legal intervention. However, the same testing found that those with mental health issues had a statistically significant difference in scores (P = 0.06), with the mean score for this group increasing from 28 to 32.
Further analysis was conducted, including a correlation matrix of the WEMWBS measurements of mental wellbeing. This correlation matrix produced a Bartlett’s Test of Sphericity p value of 0.000, providing evidence that the variables in our correlation matrix have a significant relationship, and are not orthogonal.
The correlation matrix assumes the 14 variables can be reduced to two variables that explain 69% variance in the data ().
Table 1. Total variance of 14 WEMWBS variables, showing 2 latent variables accumulating to 69% variance.
Notably, one variable accounts for 59% variance and the other for 10% variance. A rotated component matrix found two latent variables (), which can be described as “Cognitive Factors” (LV1), and “Affective Factors” (LV2) as the variables associated with LV1 are concerned with thoughts and understanding, whereas LV2 is focused on feelings and moods (shown in ).
Table 2. Rotated component matrix of the 14 WEMWBS variables.
Table 3. 14 variables reduced to 2 latent factors from the rotated component matrix.
Further non-parametric testing (Wilcoxon Signed Rank Test) on the latent variables found that the LV2 WEMWBS scores significantly increased after the intervention (p = 0.016), whereas the LV1 increase in scores was not statistically significant (p = 0.074).
Mental health factors were the only recorded characteristic which demonstrated a significant association with significant change in WEMWBS scores post-intervention. Notably, veterans who disclosed mental health issues upon referral (n = 53), had significantly higher LV1 and LV2 scores after the legal advice, casework or support intervention (LV1, p = 0.023; LV2, p = 0.001). However, those who did not report mental health issues at the start of the intervention (n = 14) had no significant change in either LV1 or LV2 scores (LV1, p = 0.624; LV2, p = 0.378).
It is important to note that the sample size for those without mental health issues (n = 14) upon referral, is small. It is possible that the legal advice and support intervention had some impact on WEMWBS scores. Yet if it did have an impact, the data shows the effect is smaller than the effect observed for those with mental health issues upon referral.
Discussion
Law has been recognised as “arguably one of the most important social determinants of health (SDH)” (Genn Citation2019, p. 162; Tsai et al. Citation2017). Many studies in the public health literature have ignored the important role of law as a SDH at the micro-level and focused more on law as a population-wide intervention. This has led some to conclude that “the need for free legal services to improve health at a local or individual level has largely been overlooked” (Beardon et al. Citation2020, p. 1; Granger et al. Citation2022, p. 2). Our findings show that micro-level legal advice interventions have an important role to play in addressing downstream (micro-level) SDH (Genn Citation2019, p. 161). The lack of free legal support for veterans in the UK also attributes to this research gap, with the Veterans Legal Link project uniquely providing a full suite of free legal advice and case work and specialist support services to veterans and their families (Brown Citation2023).
Whilst a great deal has been written about US veterans, comparatively little has been written about the experience of British veterans (Iversen et al. Citation2005; Larkin et al. Citation2016). It is now accepted that the transition challenges facing UK military service leavers are inadequately reflected in the literature, and hence necessitate further empirical research to advance and expand support services uniquely tailored to the UK veteran population (Larkin et al. Citation2016). It should be pointed out in this regard that scant research exists on the social determinants of mental illness within the UK Armed Forces and in the veteran population (Fossey et al. Citation2018).
Furthermore, there is a distinct gap in access to support for veterans in a formal, non-clinical, non-medical manner (Stevelink et al. Citation2019). Alongside this gap in support for the veteran population, there is evidence that the rate of PTSD is higher among veterans, at 7.4%, than the general public at 4% (Murphy and Busuttil Citation2019, p. 1). However, Fulton et al. (Citation2019), delineates a sentiment amongst veterans that civilian medical services do not understand them, and Ahern et al. (Citation2015, p. 5) document the feeling of “normal is alien” upon transitioning into civilian life. This demonstrates the need for more research into these formal, non-medical support services and into their efficacy and feasibility in addressing the social determinants that cause mental ill health. Notably, some contemporary studies have provided non-medical support for veterans using WEMWBS to assess the efficacy and feasibility of the intervention (Everill et al. Citation2020; Kay et al. Citation2022; Roberts et al. Citation2019). However, to our knowledge this is the first study to use the WEMWBS to evaluate the feasibility of remotely delivered legal advice as a social intervention for supporting the mental wellbeing UK veterans.
Significance of the study
This paper contributes to three distinct strands of literature. First, it contributes to the body of work on veterans’ mental health through the lens of positive mental health. This paper is also adding to the growing literature on the role of legal advice as a social intervention. Finally, the paper contributes to the large literature on mental wellbeing interventions. The recognition that negative social determinants of health can adversely affect the mental wellbeing of UK veterans combined with the growing demand for more tailored mental health support services among veterans (Dafydd Citation2023), draw attention to the need to deploy effective social interventions. This research provides empirical evidence which can inform veterans’ mental health policy and practice, through a focus on legal advice and support intervention. Notably, veteran participants in this study adaptively responded to the legal intervention, as was shown by the overall increase in the WEMWBS scores and a statistically significant increase in the average WEMWBS score post-intervention for individuals disclosing mental health issues. This provides unique insight into how tailored legal advice and support can improve the mental wellbeing of this population.
Our finding that the LV2 WEMWBS score significantly increased after the intervention (p = 0.016), whereas the LV1 increase in score was not statistically significant (p = 0.074), indicates that the affective dimension of wellbeing plays a more central role in veterans’ wellbeing than the cognitive dimension. It is possible to speculate that legal advice and services provided to veterans with CMDs elicited emotional disclosure, which in turn increased positive emotion and correspondingly decreased negative emotion (Schüler et al. Citation2009), resulting in improved mental wellbeing (Bernard et al. Citation2006; Edwards and Kotera Citation2021; Mendolia and Kleck Citation1993; Sloan et al. Citation2005; Winick Citation2000). Allmark et al. (Citation2013, p. 63) described this as a “counselling effect”, a phenomenon wherein the positive impact of being listened to can improve one’s health. These findings suggest the importance of individualised and “client-centred” interventions for veterans. In other words, clients respond well when they are being understood and listened to on a personal basis. Something which may be particularly salient to veterans, who may be more inclined to believe civilian services do not understand them (Fulton et al. Citation2019; Dandeker et al. Citation2003) and who have a tendency to be less likely to self-disclose due to masculine military norms (McAllister et al. Citation2019; Osorio et al. Citation2012; Walker Citation2010). Moreover, disclosure in a legal setting may alleviate the disinclination towards emotional disclosure as it is necessary for the work being conducted on the client's behalf (Hazard Citation1978). Therefore, research and development of interventions in the legal space that encourage affective aspects of wellbeing could be uniquely useful in improving the mental wellbeing of veterans.
Finally, our findings also develop understandings of the modes of delivery for social interventions. In their systematic review, Young and Bates (Citation2022) found that the accessibility of advice services influences health and wellbeing outcomes. However, it should be pointed out that they are referring to studies that show that co-locating advice services in GP surgeries increase clients’ ability to access these services. In contrast, the legal advice service delivered in this study was conducted remotely with the aim of counteracting systemic inequalities faced by our clients who are often located in rural Wales, where there are barriers to accessing legal services (Olusanya et al. Citation2022). Therefore, more research is needed into the impact of different modes of delivery of advice service interventions (face to face, telephone or online formats) and also to compare their relative cost-effectiveness.
Conclusion
This study sought to investigate the impact of legal advice and support services on the mental health of UK veterans facing potential legal issues. Drawing from a dataset obtained from Veterans Legal Link's casework database (Auxilium), this research evaluated the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS) scores of UK veterans pre and post legal intervention. Findings of this analysis reveal a statistically significant increase in median WEMWBS scores following the receipt of free, remotely delivered legal advice and support services. This increase in the average WEMWBS score was particularly significant amongst the veterans who self-reported mental health issues at the beginning of the intervention.
Furthermore, this study primarily highlights the potential of legal advice as a micro-level social determinant of mental health (SDMH) intervention, thereby filling a critical gap in the existing literature. By addressing potential legal issues that induce stress, Veterans Legal Link, as a legal advice service, demonstrated the capacity to positively influence the mental wellbeing of UK veterans. Specifically, the analysis of latent variables in this study suggests that the affective dimensions of wellbeing, such as emotional disclosure facilitated by a client-centred approach to legal practice, play a central role in improving mental health outcomes through inducing a potential “counselling effect”. In addition, the significance of this study lies in its contribution to understanding the mental wellbeing dynamics within the UK veteran population, and the efficacy of legal interventions in addressing social determinants of mental health.
Based on the above findings, we recommend the development of tailored services for UK veterans that integrate legal advice as a fundamental aspect of enhancing their wellbeing. Notably, this study demonstrated that a legal advice setting has the potential to improve wellbeing for clients with CMDs. In essence, legal advice worked symbiotically with a client-centred approach to produce a positive effect, as the legal setting and professionals facilitated veterans’ emotional disclosure. This is particularly important bearing in mind the fact that studies have shown that a negative relationship exists between the military culture of “toughness” and emotional disclosure (McAllister et al. Citation2019; Osorio et al. Citation2012), with emotional challenges being perceived as a weakness (Walker Citation2010). This finding also has more general implications for the legal profession as some scholars have argued that “lawyers fail to pay sufficient attention to the emotional consequences that accompany their practice” (Marson et al. Citation2019, p. 142). It follows that from a practical perspective, legal practitioners working with veterans may modify their practices to ensure a more client-centred approach so as to produce positive wellbeing outcomes. In this sense, lawyer-client communication should be optimised to ensure that it is open, welcoming, and facilitates a “counselling effect” when working with veteran clients. This could be done by strengthening two-way communications, or adopting a specific two-way communication model, in order to ensure that clients have the opportunity for emotional disclosure, and to discuss how the potential legal issue is impacting their wellbeing. More research should be conducted on optimising the client experience and ensuring open and effective bidirectional communication between legal professionals and veteran clients, particularly in a remotely delivered manner.
The limitations of this study included the following. First, a small sample size of those not reporting mental health issues (n = 14), which can be attributed to the challenges in getting all clients to complete both the pre and post intervention WEMWBS survey. We cannot rule out the possibility of the legal advice intervention having some impact on WEMWBS scores for this group, but it does not show in this sample size. Thus, this study should be revisited with additional data collected overtime from the Veterans Legal Link casework database.
Furthermore, a second limitation is that at the time of the post-intervention survey, not all legal cases had been resolved. Some clients who responded to the survey had received free legal advice and support, but still had an ongoing case. Future research should be designed longitudinally and should ensure that participants are asked to complete follow-up WEMWBS surveys at regular intervals. This would alleviate the limitations of this study and could show if mental wellbeing improves throughout the full legal case timeline, or if it peaks or declines at certain points.
Essentially, while this study underscores the potential role of legal advice interventions in improving the mental wellbeing of UK veterans, further (longitudinal) research is warranted to address the above-mentioned limitations. Building upon this research will advance our understanding of the law as a social determinant of health, and legal advice as a micro-level intervention to improve mental wellbeing outcomes in this population.
Disclosure statement
No potential conflict of interest was reported by the author(s).
Ethical Approval ID: 20739
Additional information
Funding
References
- Ahern, J., Worthen, M., Masters, J., Lippman, S. A., Ozer, E. J. & Moos, R. (2015) The challenges of Afghanistan and Iraq veterans’ transition from military to civilian life and approaches to reconnection, PLoS One, 10, pp. 7. doi:10.1371/journal.pone.0128599
- Allmark, P., Baxter, S., Goyder, E., Guillaume, L. & Crofton-Martin, G. (2013) Assessing the health benefits of advice services: using research evidence and logic model methods to explore complex pathways, Health & Social Care in the Community, 21(1), pp. 59–68. doi:10.1111/j.1365-2524.2012.01087.x
- Aruta, J. J. B. R., Almazan, J. U., Alamri, M. S., Adolfo, C. S. & Gonzales, F. (2022) Measuring mental well-being among frontline nurses during the COVID-19 crisis: evidence from Saudi Arabia, Current Psychology, 4, pp. 1–11.
- Beardon, S., Woodhead, C., Cooper, S., Raine, R. & Genn, H. (2020) Health-justice partnerships: innovation in service delivery to support mental health, Journal of Public Mental Health, 19(4), pp. 327–332. doi:10.1108/JPMH-03-2020-0018
- Bernard, M., Jackson, C. & Jones, C. (2006) Written emotional disclosure following first-episode psychosis: effects on symptoms of post-traumatic stress disorder, British journal of clinical psychology, 45(3), pp. 403–415. doi:10.1348/014466505X68933
- Blodgett, J. M., Birch, J. M., Musella, M., Harkness, F. & Kaushal, A. (2022) What works to improve wellbeing? A rapid systematic review of 223 interventions evaluated with the Warwick-Edinburgh Mental Well-Being Scales, International Journal of Environmental Research and Public Health, 19(23), pp. 15845.
- Brown, T. (2023) England and Wales Guide 2023. Pro Bono Week, Available at: https://probonoweek.org.uk/wp-content/uploads/2024/01/Guide_to_Pro_Bono_and_Other_Free_Advice_in_England__Wales_November_2023.pdf, accessed 26 April 2024.
- Dafydd, S. (2023) Mental health: growing demand for veteran support, charities warn. BBC. Available at: https://www.bbc.co.uk/news/uk-wales-67759299#:~:text=%22There%20was%20no%20support%20with,of%20831%20in%202019-20, accessed 25 March 2023.
- Dandeker, C., Wessley, S., Iversen, A. & Ross, J. (2003) Improving the Delivery Of Cross Departmental Support And Services For Veterans, A Joint Report of the Department of War Studies and Institute of Psychiatry, King's College London to the UK Ministry of Defence, July.
- Edwards, A. M. & Kotera, Y. (2021) Mental health in the UK Police Force: a qualitative investigation into the stigma with mental Illness, International Journal of Mental Health and Addiction, 19, pp. 1116–1134. doi:10.1007/s11469-019-00214-x
- Everill, P., Bennett, R. & Burnell, K. (2020) Dig in: an evaluation of the role of archaeological fieldwork for the improved wellbeing of military veterans, Antiquity, 94(373), pp. 212–227.
- Finnegan, A. & Randles, R. (2022) Prevalence of common mental health disorders in military veterans: using primary healthcare data, BMJ Military Health, pp. 1–6.
- Fossey, M., Godier, L., Caddick, N., Klein, S. & Cooper, A. (2018) Written evidence submitted by Anglia Ruskin University: Evidence on Mental health and the Armed Forces Part One. UK Parliament. Available at: https://committees.parliament.uk/writtenevidence/88134/html/, accessed 18 January 2024.
- Fulton, E., Wild, D., Hancock, J., Fernandez, E. & Linnane, J. (2019) Transition from service to civvy street: the needs of armed forces veterans and their families in the UK, Perspectives in Public Health, 139(1), pp. 49–58. doi:10.1177/1757913918785650
- Genn, H. (2019) When law is good for your health: mitigating the social determinants of health through access to justice, Current Legal Problems, 72(1), pp. 159–202. doi:10.1093/clp/cuz003
- Granger, R., Genn, H. & Edwards, R. Tudor (2022) Health economics of health justice partnerships: a rapid review of the economic returns to society of promoting access to legal advice, Frontiers in Public Health, 10. doi:10.3389/fpubh.2022.1009964
- Grant, F., Guille, C. & Sen, S. (2013) Well-being and the risk of depression under stress, PLoS One, 8(7), p. e67395.
- Hazard, G. C. Jr. (1978) An historical perspective on the attorney-client privilege, California Law Review, 66(5), pp. 1061–1092. doi:10.2307/3479905
- Horwood, G., Augoustinos, M. & Due, C. (2023) “It’s important to manage our stress”: mental health advice in the Australian print news media during the COVID-19 pandemic, SSM – Mental Health, 3, pp. 100204. doi:10.1016/j.ssmmh.2023.100204
- Iversen, A., Nikolaou, V., Greenberg, N., Unwin, C., Hull, L., Hotopf, M., Dandeker, C., Ross, J. & Wessely, S. (2005) What happens to British veterans when they leave the armed forces? European Journal of Public Health, 15(2), pp. 175–184. doi:10.1093/eurpub/cki128
- Kay, C., Sutton, R., Margerison, G. & McKenna, J. (2022) Providing recovery support to wounded, injured, and sick UK military personnel throughout the COVID-19 pandemic, Military Psychology, 35(5), pp. 408–419. doi:10.1080/08995605.2022.2126655
- Keyes, C. L. M. (2002) The mental health continuum: from languishing to flourishing in life, Journal of Health and Social Behavior, 43(2), pp. 207–222. doi:10.2307/3090197
- Keyes, C. L. M. & Lopez, S. J. (2002) Toward a science of mental health, in: C.R. Snyder & S.J. Lopez (Eds) Handbook of positive psychology (New York, Oxford University Press), pp. 45–59.
- Larkin, J., Sondergaard, S., Silfversten, E., Cox, K., Anderson, B., Schaefer, A. G. & Meads, C. (2016) Families support to transition: a systematic review of the evidence.
- Marson, J., Ferris, K. & Kawalek, A. (2019) A Vineyard in a law clinic, Singapore Journal of Legal Studies, pp. 124–146.
- McAllister, L., Callaghan, J. E. & Fellin, L. C. (2019) Masculinities and emotional expression in UK servicemen: ‘Big boys don’t cry’? Journal of Gender Studies, 28(3), pp. 257–270. doi:10.1080/09589236.2018.1429898
- Mendolia, M. & Kleck, R. E. (1993) Effects of talking about a stressful event on arousal: Does what we talk about make a difference? Journal of personality and social psychology, 64(2), pp. 283–292. doi:10.1037/0022-3514.64.2.283
- Ministry of Defence. (2022) UK armed forces mental health: annual summary & trends over time, 2007/08 to 2021/22. GOV.UK, Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1083916/MH_Annual_Report_2021-22.pdf, accessed 10 November 2023.
- Murphy, D. & Busuttil, W. (2019) Understanding the needs of veterans seeking support for mental health difficulties, BMJ Military Health, 166(4), pp. 211–213.
- NHS. (2016) Health Survey for England 2016 Well-being and mental health National Statistics. NHS Digital. Available at: https://files.digital.nhs.uk/CE/ADE840/hse2016-adult-wel-bei-v2.pdf, accessed 12 November 2023.
- Olusanya, O., Collier, W., Marshall, S., Knapp, V. & Baldwin, A. (2022) Access to Justice software development, participatory action research methods and researching the lived experiences of British military veterans, Journal of Legal Research Methodology, 2, pp. 3–25.
- Osorio, C., Jones, N., Fertout, M. & Greenberg, N. (2012) Perceptions of stigma and barriers to care among UK military personnel deployed to Afghanistan and Iraq, Anxiety, Stress & Coping, 26, pp. 539–557.
- Parkinson, A. & Buttrick, J. (2015) The role of advice services in health outcomes: evidence review and mapping study. Advice Services Alliance. Available at: https://asauk.org.uk/wp-content/uploads/2018/02/Role-of-Advice-Services-in-Health-Outcomes.pdf, accessed 10 November 2023.
- Peacock, S. M., McKenna, J., Carless, D. & Cooke, C. (2019) Outcomes from a one-week adapted sport and adapted adventure recovery programme for military personnel, Sports, 7(6), pp. 135. doi:10.3390/sports7060135
- Roberts, G. A., Arnold, R., Turner, J. E., Colclough, M. & Bilzon, J. (2019) A longitudinal examination of military veterans’ invictus games stress experiences, Frontiers in Psychology, 10. doi:10.3389/fpsyg.2019.01934
- Santini, Z. I., Ekholm, O., Koyanagi, A., Stewart-Brown, S., Meilstrup, C., Nielsen, L. & Thygesen, L. C. (2022) Higher levels of mental wellbeing predict lower risk of common mental disorders in the Danish general population, Mental Health & Prevention, 26, pp. 200233.
- Schotanus-Dijkstra, M., Drossaert, C. H. C., Pieterse, M. E., Boon, B., Walburg, J. A. & Bohlmeijer, E. T. (2017) An early intervention to promote well-being and flourishing and reduce anxiety and depression: a randomized controlled trial, Internet Interventions, 9, pp. 15–24. doi:10.1016/j.invent.2017.04.002
- Schüler, J., Job, V., Fröhlich, S. M. & Brandstätter, V. (2009) Dealing with a ‘hidden stressor’: emotional disclosure as a coping strategy to overcome the negative effects of motive incongruence on health, Stress and Health: Journal of the International Society for the Investigation of Stress, 25(3), pp. 221–233. doi:10.1002/smi.1241
- Sefton, M. (2010) With rights in mind: Is there a role for social welfare law advice in improving young people’s mental health? Youth Access, London.
- Shah, N., Cader, M., Andrews, B., McCabe, R. & Stewart-Brown, S. L. (2021) Short Warwick-Edinburgh Mental well-being Scale (SWEMWBS): performance in a clinical sample in relation to PHQ-9 and GAD-7, Health and Quality of Life Outcomes, 19, pp. 1–9. doi:10.1186/s12955-020-01607-6
- Sloan, D. M., Marx, B. P. & Epstein, E. M. (2005) Further examination of the exposure model underlying the efficacy of written emotional disclosure, Journal of consulting and clinical psychology, 73(3), pp. 549–554. doi:10.1037/0022-006X.73.3.549
- Stevelink, S. A. M., Jones, N., Jones, M., Dyball, D., Khera, C. K., Pernet, D., MacCrimmon, S., Murphy, D., Hull, L., Greenberg, N., MacManus, D., Goodwin, L., Sharp, M. L., Wessely, S., Rona, R. J. & Fear, N. T. (2019) Do serving and ex-serving personnel of the UK armed forces seek help for perceived stress, emotional or mental health problems? European Journal of Psychotraumatology, 10(1), pp. 1556552. doi:10.1080/20008198.2018.1556552
- Tennant, R., Fishwick, R., Platt, S., Joseph, S. & Stewart-Brown, S. (2006) Monitoring positive mental health in Scotland: validating the Affectometer 2 scale and developing the Warwick-Edinburgh Mental Well-being scale for the UK (Glasgow, NHS Health Scotland).
- Tsai, J., Middleton, M., Villegas, J., Johnson, C., Retkin, R., Seidman, A., Sherman, S. & Rosenheck, R. (2017) Medical-legal partnerships at veterans affairs medical centers improved housing and psychosocial outcomes for vets, Health Affairs, 36(12), pp. 2195–2203. doi:10.1377/hlthaff.2017.0759
- Walker, S. (2010) Assessing the mental health consequences of military combat in Iraq and Afghanistan: a literature review, Journal of Psychiatric and Mental Health Nursing, 17(9), pp. 790–796. doi:10.1111/j.1365-2850.2010.01603.x
- Warwick Medical School. (2023) Collect, Score, Analyse, and Interpret WEMWBS. Available at: https://warwick.ac.uk/fac/sci/med/research/platform/wemwbs/using/howto/, accessed 17 December 2023.
- Winick, B. (2000) Symposium: creative problem solving conference–therapeutic jurisprudence and the role of counsel in Litigation, California Western Law Review, 37(1), pp. 8.
- Wintersteiger, L. (2015) Legal Needs, Legal Capability and the Role of Public Legal Education. A Report by Law for Life: The Foundation for Public Legal Education, London.
- World Health Organization. (2022) Mental Health. WHO. Available at: https://www.who.int/news-room/fact-sheets/detail/mental-health-strengthening-our-response, accessed 10 April 2024.
- Young, D. & Bates, G. (2022) Maximising the health impacts of free advice services in the UK: a mixed methods systematic review, Health & Social Care in the Community, 30, pp. 1713–1725.