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Mills started her own model agency in 1986, and married Alfie Karmal on 6 May 1989, but divorced him in 1991. Mills was living with her ski instructor Miloš Pogačar in Croatia in 1990, just before the Croatian War started, and later organised supplies for Croatia, accepting modelling assignments in Austria to pay for the trip. In London in 1993, Mills was hit by a police motorbike and suffered serious injuries, losing part of her left leg, six inches below her knee. She later sold her story to the News of the World and used the proceeds to establish the Heather Mills Health Trust, which recycles discarded prosthetic limbs.

Mills met McCartney at a Pride of Britain charity event, and they were married on 11 June 2002. Mills gave birth to Beatrice Milly McCartney on 28 October 2003. Mills separated from McCartney in 2006, which led to a highly publicised divorce in which she was awarded £24.3 million in a court settlement on 17 March 2008. Mills is a patron of Viva!, the Vegetarian and Vegan Foundation, vice-president of the Limbless Association and was formerly a Goodwill Ambassador for the United Nations Association Adopt-A-Minefield program. She continues to work on behalf of various campaigns, including aid for amputees, animal rights and for the banning of land mines.

Mills' mother left home when Mills was nine years old, which left Mills, her older brother Shane, and her younger sister, Fiona, in the care of their father. Mills said that her father once threw her brother against a window for making a mess on the carpet with crayons. The window broke and her brother had to be taken to hospital, where Mills' father explained that the boy had fallen on some glass in the garden. Fiona Mills said: "Our family were always short of money and our father demanded that we find food and clothes so we turned to shoplifting, learnt to hide from the bailiffs and became experts at domestic duties. I'm not ashamed to say that we were forced to steal because when you are a young child, you'd rather do that than face a beating from your father". (Their father disputed his daughters' allegations that he was violent towards them, later releasing home movies of family holidays in Wales, showing Mills playing happily). Mills later wrote that she often stole food from supermarkets as a child: "By ten I was an old hand. Pinching food was really quite easy I discovered". In 2006, she visited the Sainsbury's store in her home town and was refused entry by a member of staff because she had once been caught shoplifting there.

After returning to London, Mills asked Karmal to marry her. Karmal said yes, but on one condition: "I told her I couldn't marry her until she did something about her compulsive lying, and she agreed to see a psychiatrist for eight weeks. She admitted she had a problem and said it was because she'd been forced to lie as a child by her father". Mills had told Karmal that she had a driving licence, and three A-levels, which Karmal later learned was not true. On 6 May 1989, Mills married Karmal (who had two sons from a previous marriage), and moved into a four-bedroom house in Dobbs Weir, Hertfordshire. Although Mills proposed to Karmal, she later said that every man she has been out with "has asked me to marry him within a week". While married to Karmal, she suffered two ectopic pregnancies, so Karmal paid for her to go on holiday to Croatia with his children and ex-wife (with whom Mills had become friends), in 1990, but Mills ended up living with her ski instructor, Pogačar, shortly before the Croatian War began. Mills then set up a refugee crisis centre in London, helping over 20 people to escape the war. She drove by herself to deliver donations to Croatia, taking modelling assignments in Austria on the way to pay for the trip, later saying that she "worked on the front line in a war zone in the former Yugoslavia for two years where there were mines everywhere that weren't marked". Karmal and Mills were divorced in 1991, and Karmal now lives in Vancouver, Canada. Mills was later engaged to Raffaele Mincione (a bond dealer for the Industrial Bank of Japan) in 1993.