In September, the Minister of Health, Mike Nesbitt MLA, was asked in an Assembly Question to detail the number of individuals who were dispensed anti-psychotic medication in the Belfast Health and Social Care Trust, in each of the last five years.

His response? That Belfast HSC Trust’s electronic care records “cannot extrapolate this specific information, so are unable to provide this information”.

The statement suggests that information on medicines prescribed and dispensed within the Belfast Trust is simply not retrievable from its electronic records. Subsequently, PPR enquired about the availability of these statistics with the HSC Business Services Organisation (BSO), which manages prescription data across Northern Ireland. The BSO were able to provide these figures almost immediately, showing that around 10,000-11,000 individuals in Belfast receive antipsychotic medication each year — a number that has remained broadly stable since 2020/21. They also provided us with breakdowns of the number of individuals dispensed anti-psychotics by age group, gender, and deprivation quintile from 2020/21 to 2024/25 (view the detailed breakdown here). If the BSO can access and share this level of detail without issue, why can’t the Belfast Trust?

The Minister’s claim exposes more than bureaucratic confusion or a one-off oversight. It raises serious questions as to the regular monitoring of this data by HSC Trusts and the Department of Health, highlighting deeper issues of transparency and accountability around mental health data.

A Systemic Blind Spot

Long-standing failures to collect, share, and use mental health data effectively in Northern Ireland are well documented. A review by the Office for Statistics Regulation in 2021 highlighted significant limitations in mental health data in Northern Ireland, with the scarcity of robust data leading to significant data gaps. In particular, it highlighted a lack of outcome data in respect to mental health services. Without this data the Department of Health and Health and Social Care Trusts cannot determine whether the services provided improve patient mental health and reflect value for money. In 2023, the Northern Ireland Audit Office (NIAO), in its report on mental health services, also concluded that significant limitations exist in relation to mental health data in Northern Ireland. In June 2024, a report by the NI Assembly’s Public Accounts Committee found that data on mental health was extremely poor, something that was unacceptable and that needed to be improved urgently.

Finally, we have had an ongoing ‘cart before the horse’ situation where, more than four years into its ten-year Mental Health Strategy, the Department of Health still does not have an Outcomes Framework in place to capture the data necessary to assess the strategy’s impact.

Why It Matters

Mental health is one of the most pressing public health challenges in Northern Ireland with high rates of mental ill health, suicide, and medication use compared with the rest of the UK. Without the availability of timely, accurate, reliable, coherent, and comparable data, it is impossible to plan services effectively, to assess outcomes, and for politicians and the public to hold the Department and the HSC Trusts to account for how public money is being spent.

Looking at the BSO figures, it is striking how stark the difference in antipsychotic prescribing rates is between those living in the most deprived areas and those in the least deprived areas.

Moreover, the confusion in accessing this data raises serious concerns about how people taking antipsychotic medication are being monitored and reviewed in line with clinical and departmental guidelines in Belfast and across HSC Trusts.

Looking at the BSO figures, it is striking how stark the difference in antipsychotic prescribing rates is between those living in the most deprived areas and those in the least deprived areas. Over half (53%) of individuals prescribed an antipsychotic lived in the most deprived 20% of areas in Belfast. These numbers suggest a real policy need for resourcing appropriate community-based services and supports in these areas.

A Question of Transparency, Not Technology

The issue appears less about technology and more about governance and culture. If one branch of the health system (the BSO) can access this data immediately but another (the Department) insists it cannot, the problem lies in how information is shared and the will of institutions to make it public. When open data and evidence-based policy should be standard practice, this lack of coherence is difficult to justify.

The Bigger Picture

Northern Ireland’s mental health strategy promised:

• A clear, evidence-based outcome framework which allows evidence to be the foundation for decision making.

• A robust data set which is comparable across Trusts to measure performance and to determine what works.

Yet, more than four years since those commitments, the same barriers remain. The inability — or unwillingness — to provide fundamental prescribing data speaks volumes about how far there is still to go. The Department of Health says the data cannot be extracted. The BSO says it is already there. The Office for Statistics Regulation, the NI Audit Office and the NI Public Accounts Committee all point to the Department of Health’s chronic and systemic failures when it comes to mental health data.

In a mental health crisis, this kind of ignorance amounts to neglect.

PPR’s New Script for Mental Health activists have been calling both for increased accountability and improved community networks and supports through their Give 5 Framework launched on World Mental Health Day 2024. To find out more visit  Take Action | Let's fix the system - not the person! | PPR