Data Insight: Mental health and homelessness in Northern Ireland

New analysis of linked administrative data reveals that people presenting as homeless in Northern Ireland are far more likely to be prescribed psychotropic medication than those who do not, with rates rising fastest among young women. The findings point to an urgent need for targeted mental health and housing support.

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This analysis linked population-level administrative data to explore trends in mental ill-health among people who presented for statutory homelessness assistance in Northern Ireland between 2012 and 2021. Psychotropic medications (used to manage symptoms of mental and behavioural disorders) were used as an indicator of mental ill-health. Based on anonymised Northern Ireland Housing Executive data, homelessness was divided into three groups: statutory homelessness (individuals whose applications were accepted, i.e. Full Duty Applicants), non-statutory homelessness (individuals whose applications were not accepted), and people who did not present as homeless during the study period.

The analysis found that a greater proportion of individuals who presented as homeless were dispensed psychotropic medications compared to those without a homelessness presentation, with the highest rates relating to antidepressants and the lowest relating to treatment for alcohol and substance use disorder. Between 2012 and 2021, there was an increase in the proportion of homeless presenters receiving psychotropic medications, with variation by sex and age group. This increase was seen for both statutory (40.3% to 50.8%) and non-statutory homeless presenters (30% to 37.3%). The most pronounced variation was observed among females aged 18 to 24 experiencing statutory homelessness, rising from 19.9% in 2012 to 30.9% in 2021.

What we did

This study linked several anonymised administrative datasets, including the Housing Executive's Housing Management System (which records all presentations for statutory homelessness assistance in Northern Ireland), the National Health Application and Infrastructure Services (NHAIS) dataset (covering all individuals registered with a GP in Northern Ireland, providing a population spine for the study, and socio-demographic data including sex and age), General Register Office (GRO) death registrations (used to identify when individuals were no longer eligible for inclusion), and the Enhanced Prescribing Database (capturing medications prescribed by a GP and dispensed by community pharmacists).

Individuals were included if they were adults aged 18 or over, alive, and registered anytime between 1 January 2012 and 31 December 2021. Psychotropic medications included in the analysis were antidepressants, anxiolytics, hypnotics, antipsychotics, and medications for treatment of alcohol or substance use disorder. Only instances where individuals had three or more medications recorded in a calendar year were counted, to exclude transient episodes of medication use less likely to indicate mental ill-health. The Business Service Organisation Honest Broker Service (HBS) provided access to the linked, de-identified research datasets within a Trusted Research Environment, and ethical approval was granted by the Research Ethics Committee (reference 22/SC/0065).

Why it matters

Homelessness and poor mental health are major, interconnected public health challenges. Building on existing evidence, this study found a high prevalence of poor mental health, using psychotropic medications as a proxy indicator, among people named on homelessness applications, drawing on ten years of linked administrative data. By distinguishing between people experiencing statutory and non-statutory homelessness, the study highlights important differences in mental health needs, especially among those who fall short of the threshold for statutory assistance.

These findings highlight a key opportunity to design targeted interventions and shape policy to better support people presenting as homeless in Northern Ireland. Differences between people experiencing statutory and non-statutory homelessness underline the need for comprehensive support for all who seek help. Demographic patterns by sex and age offer further direction for service planning, and in particular, the rising number of younger females in statutory homelessness receiving psychotropic medication signals a critical need for targeted mental health and housing support.