New ADR NI research reveals strong links between homelessness and poor mental health in Northern Ireland

New ADR Northern Ireland research has analysed a decade of population-level administrative data to explore the trends in mental ill-health in people who have experienced homelessness. In conjunction with a second insight written from the perspectives of people with lived experience, this study highlights the strong relationship between homelessness and mental ill-health and encourages policymakers to “see the person, not just the problem”.

Using anonymised linked health and homelessness data from the National Health Application and Infrastructure Services (NHAIS), the General Register Office (GRO), the Enhanced Prescribing Database and the Housing Executive’s Management System, researchers examined the prevalence of psychotropic medications (including antidepressants, anxiolytics, hypnotics, antipsychotics and medications used to treat alcohol or substance use disorders) among people who were named on applications to the NI Executive for homelessness assistance between 2012 and 2021.  The findings demonstrate that people experiencing homelessness are significantly more likely to request and receive mental-health-related medication.

Homelessness is not just a housing problem: it is a complex social issue.   Homelessness support services are facing growing pressure as they help people with other support needs, including mental health challenges.

The research produced some of the following key findings:

• 1 in every 50 people in Northern Ireland experienced homelessness in 2019.
• Over half (50.8%) of people experiencing statutory homelessness and more than a third (37.3%) of those whose applications were not successful received psychotropic medication in 2021, compared with 19.3% of people who did not present as homeless.
• Antidepressants were the most commonly prescribed mental health medication across all groups. 
• Between 2012 and 2021, there was a pronounced increase in receipt of mental health-related medication among people experiencing homelessness, particularly among females aged 18-24 experiencing statutory homelessness.

Why it matters

Homelessness and poor mental health are closely linked and represent significant public health challenges. Drawing on ten years of linked administrative data and the perspectives of people with lived experience, this research found high levels of poor mental health among people who have experienced homelessness, including those who did not meet the threshold for statutory support. This highlights the importance of providing comprehensive support to everyone who seeks help. The findings also provide valuable evidence to inform targeted interventions, service planning and policy development.

People with lived experience were clear on the need for earlier intervention, better joined-up services, holistic mental health support and action to address the stigma surrounding homelessness, recognising that negative attitudes can create additional barriers to accessing help.

With Northern Ireland reported to have the highest prevalence of mental health issues in the UK, there is an urgent need for coordinated action that addresses both homelessness and mental ill-health while ensuring policymakers and service providers listen to the voices of those with lived experience.

Read the data insights:

Mental Health and Homelessness in Northern Ireland

Mental Health and Homelessness: The Lived Experience

This research was supported by ADR UK (Administrative Data Research UK), a partnership transforming the way researchers access the UK's rich collection of public sector data to enable better-informed policy decisions that improve people's lives. ADR UK is an Economic and Social Research Council (ESRC) investment, part of UK Research and Innovation (Grant No. ES/W010240/1).

The authors would like to acknowledge the help provided by the staff of the Honest Broker Service (HBS) within the Business Services Organisation Northern Ireland (BSO). The HBS is funded by the BSO and the Department of Health (DoH). The authors alone are responsible for the interpretation of the data, and any views or opinions expressed are solely those of the authors and do not necessarily represent those of the BSO.

The authors also wish to acknowledge the Health & Homelessness Research Steering Group for its advice and guidance throughout the research. The Steering Group comprised representatives from the Northern Ireland Housing Executive (Brian O'Kane, Richard Tanswell, Catherine Carey and Stephen Buggy), the Department for Communities (David Polley and Gillian McMaster), the Department of Health (Scott Taylor and Edel Walsh), the Public Health Agency (Kevin Bailey and Tracey Colgan), Homeless Connect (Nicola McCrudden), and Simon Community NI (Karen McAlister).

Finally, the authors would like to thank Homeless Connect, Echoes of Home and the individuals with lived experience of homelessness who contributed to and informed the research.