Inequities in mental health services among Aboriginal and Torres Strait Islander people in Australia

Aboriginal and Torres Strait Islander peoples experience disproportionately higher rates of mental health disorders and often face barriers to accessing and utilising culturally appropriate mental health services. This study investigated the disparities and determinants of mental health service utilisation among Indigenous Australians.

This is a cross-sectional study.

This study used the 2018-19 National Aboriginal and Torres Strait Islander Health Survey. Our analysis included Indigenous adults aged 18 years and older with mental health conditions. Wagstaff's normalised concentration indices were employed to examine inequalities in mental health services uptake, and Bayesian logistic regression analysis was used to identify the factors driving these inequalities.

This study analysed a weighted sample of 1870 adults, of which 59.5 % were female. Our findings showed that mental health utilisation was more concentrated among the least socioeconomically disadvantaged Indigenous adults (WCI = 0.11; 95 % CI: 0.06, 0.17). These socioeconomic disparities were higher in Western Australia (WCI = 0.35; 95 % CI: 0.20, 0.49) and Southern Australia (WCI = 0.22; 95 % CI: 0.04, 0.39). Similarly, a higher mental health uptake was observed among individuals with a higher level of education (WCI = 0.18; 95 % CI: 0.13, 0.23), while older adults had a lower uptake (WCI = -0.11; 95 % CI: 0.16, -0.05). Factors positively associated with mental health services uptake included the availability of doctors at one's local Aboriginal Community Controlled Health Services (aOR = 1.27; 95 % CrI: 1.01, 1.60), being married (aOR = 1.49; 95 % CrI: 1.26, 1.75) and self-rated poor health status (aOR = 1.27; 95 % CrI: 1.01, 1.60). However, Indigenous adults experiencing financial stress (aOR = 0.82; 95 % CrI: 0.70, 0.97) and residing in remote (aOR = 0.79; 95 % CrI: 0.63, 0.99) or very remote areas (aOR = 0.63; 95 % CrI: 0.53, 0.74) were less likely to utilise mental health services.

This study found inequalities in mental health services uptake among Indigenous Australians with notable variation across states. Key policy interventions to mitigate this include promoting economic empowerment, expanding digital mental health services in remote and rural areas and providing age-appropriate mental health services for older adults.