Antipsychotic Prescribing Trends in England: The Role of Regional Disparities, Health Inequalities, and Ethnic Density

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.