Factors associated with Medicare mental health service use by Aboriginal and Torres Strait Islander adults and children in an urban area: A case study from Southeast Queensland
Xiaoyun Zhou, Claudia Pagliaro, Manuel Wailan, Shuichi Suetani, Tabinda Basit, Randall Frazer (Bidjara Nation), Carmel Nelson, Yan Liu, Lihong Zhang, Roxanne Bainbridge (Gunggari/Kunja Nations), Xiang-Yu Hou, Harvey Whiteford, Sandra DiminicObjective:
This study explored differences in mental health service use between Indigenous and non-Indigenous Australians and identified related sociodemographic, mental health history and service factors in an urban Indigenous population.
Methods:
We analysed linked 2021 Census, 2021 Medicare Benefits Schedule, and composite Indigenous identifier data from the Australian Bureau of Statistics Person-Level Integrated Data Asset for 2,494,381 individuals (2.98% Indigenous) in Southeast Queensland residents.
Results:
Both crude and adjusted comparisons (controlling for sociodemographic, mental health history, and service-related factors) showed that Southeast Queensland Indigenous populations were more likely to use any Medicare Benefits Schedule–subsidised mental health services than non-Indigenous populations. They used less total mental health sessions on average, waited more days between mental health care plan and follow-up treatment, had fewer psychotherapy sessions, a higher percentage of bulk-billed sessions, and incurred lower average gap payments. Indigenous males, those aged 40 years or older, not speaking an Aboriginal language at home, having unstable housing, lower education attainment, and no history of mental illness were less likely to use any services. Those receiving psychotherapy treatment sessions, having a history of mental illness, being unemployed or not in the labour force, aged 40–54 years old, and having a post-secondary degree used more services.
Conclusions:
While more Indigenous populations used any Medicare Benefits Schedule mental health services, lower psychotherapy use and longer wait times for follow-ups suggest ongoing inequities. Subgroups like men and those with lower education levels may need targeted interventions for equitable mental health care.