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Background: Migrant populations are particularly at risk of not receiving the care for mental ill-health that they require for a range of reasons, including language and other barriers to health service access. This record linkage study compares, for migrant and settled communities, the likelihood that a person in Northern Ireland with poor mental health will receive psychotropic medication., Methods: A cohort of 78 267 people aged 16-64 years (including 1736 migrants) who reported chronic poor mental health in the 2011 Census records was followed for 15 months by linkage to a centralised prescribing data set to determine the rates of pharmacological treatment. Logistic regression analyses quantified the relationship between psychotropic medication uptake and migrant status, while accounting for relevant demographic and socioeconomic factors., Results: Overall, 67% of the migrants with chronic poor mental health received at least one psychotropic medication during the study period, compared to 86% for the settled population; this equates to an OR of 0.32 (95% CI 0.29 to 0.36) in the fully adjusted models. Adjustment for English proficiency did not significantly alter these models. There was also considerable variation between individual migrant groups., Conclusion: Although this study suggests substantial unmet need for treatment of poor mental health among the migrant population of Northern Ireland, further qualitative studies are required to better understand how different migrant groups respond to mental ill-health., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.)