Abstract
Background:
Antipsychotics are essential for managing certain mental disorders; however, little is known about regional disparities in their prescribing or how these patterns are shaped by ethnic density and health inequalities.
Aims:
To analyse national, regional and local integrated care board trends in antipsychotic prescribing in England from April 2019 to March 2025, and to explore their associations with health inequalities and ethnic density.
Method:
A population-level observational study was conducted using the English primary care prescription data from OpenPrescribing. Linear regression was used to assess trends in first-generation (FGA), second-generation (SGA) and total antipsychotic prescribing. Generalised additive models examined associations between prescription rates and health inequalities and ethnic density at the local level.
Results:
Antipsychotic prescribing increased from 185.55 to 199.85 prescriptions per 1000 population between April 2019 and March 2025. SGA use increased significantly (168.48 to 186.27) whereas FGA use declined (17.08 to 13.58). Regional annual increases ranged from 3.85% (95% CI = 3.53%, 4.16%) in London to −0.21% (95% CI = −0.72%, 0.31%) in the South-West region, with greater variation at the local level, from 6.62% (95% CI = 5.71%, 7.53%) in North Central London to −2.05% (95% CI = −2.71%, −1.40%) in Shropshire, Telford and the Wrekin. Higher Pakistani ethnic density was associated with lower prescribing rates, whereas greater health inequalities were linked to increased prescribing.
Conclusions: Antipsychotic prescribing patterns have shifted in recent years, with notable regional disparities influenced by health inequalities and ethnic composition. Targeted interventions are needed to promote equitable access and address prescribing disparities in mental healthcare.
Antipsychotics are essential for managing certain mental disorders; however, little is known about regional disparities in their prescribing or how these patterns are shaped by ethnic density and health inequalities.
Aims:
To analyse national, regional and local integrated care board trends in antipsychotic prescribing in England from April 2019 to March 2025, and to explore their associations with health inequalities and ethnic density.
Method:
A population-level observational study was conducted using the English primary care prescription data from OpenPrescribing. Linear regression was used to assess trends in first-generation (FGA), second-generation (SGA) and total antipsychotic prescribing. Generalised additive models examined associations between prescription rates and health inequalities and ethnic density at the local level.
Results:
Antipsychotic prescribing increased from 185.55 to 199.85 prescriptions per 1000 population between April 2019 and March 2025. SGA use increased significantly (168.48 to 186.27) whereas FGA use declined (17.08 to 13.58). Regional annual increases ranged from 3.85% (95% CI = 3.53%, 4.16%) in London to −0.21% (95% CI = −0.72%, 0.31%) in the South-West region, with greater variation at the local level, from 6.62% (95% CI = 5.71%, 7.53%) in North Central London to −2.05% (95% CI = −2.71%, −1.40%) in Shropshire, Telford and the Wrekin. Higher Pakistani ethnic density was associated with lower prescribing rates, whereas greater health inequalities were linked to increased prescribing.
Conclusions: Antipsychotic prescribing patterns have shifted in recent years, with notable regional disparities influenced by health inequalities and ethnic composition. Targeted interventions are needed to promote equitable access and address prescribing disparities in mental healthcare.
| Original language | English |
|---|---|
| Article number | e72 |
| Number of pages | 12 |
| Journal | BJPsych Open |
| Volume | 12 |
| Issue number | 2 |
| Early online date | 23 Feb 2026 |
| DOIs | |
| Publication status | Published - 1 Mar 2026 |
Bibliographical note
Copyright © The Author(s), 2026. Published by Cambridge University Press on behalf of Royal College of Psychiatrists. This is an OpenAccess article, distributed under the terms of the Creative Commons Attribution licence (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.
Data Access Statement
Data are available in a public, open access repository. All data used in this study are publicly available. The data supporting this study’s findings are available from the NHS Business Services Authority (NHSBSA) (https://www.nhsbsa.nhs.uk).Keywords
- Antipsychotic
- ethnic density
- health inequalities
- England
- psychosis
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