Patterns in the access, utilisation and budget allocation of National Disability Insurance Scheme (NDIS) psychosocial support for Aboriginal and Torres Strait Islander peoples with mental health needs: a case study from South East Queensland

Equity in access to disability support services is critical for addressing health disparities faced by Aboriginal and Torres Strait Islander peoples (hereafter respectfully referred to as Indigenous Australians) in Australia. Since its rollout in 2016, the National Disability Insurance Scheme (NDIS) has faced criticism for limited access among Indigenous Australians. While systemic barriers have been identified, the extent of disparities and factors influencing access and funding remain unclear. We examined NDIS psychosocial support access and utilisation among Indigenous Australians in South East Queensland (SEQ), focusing on disparities and determinants of access and budget allocation. This study analysed Australian Bureau of Statistics Personal Level Integrated Data Asset, 2021 Census, 2021 NDIS and Medicare datasets. We examined the sociodemographic and service-related factors that were associated with access rates and budget allocation for NDIS support for psychosocial disability as primary disability among Indigenous Australians with mental health needs. Multivariate logistic regression and linear regression were used to assess associations with access and budget allocation, respectively. Indigenous Australians in SEQ accessed NDIS psychosocial support at higher rates than non-Indigenous Australians (1.75% versus 0.88%, p < 0.001), though budget allocations were comparable ($94,310.90 versus $86,371.78 per capita, p = 0.062). Access varied within Indigenous Australians based on sociodemographic factors, health service regions, and levels of need. Stable housing, lower income, and higher mental health needs were associated with greater access, whereas post-secondary education and chronic conditions were associated with lower access. Budget allocation was higher for those in group/lone households and those with greater functional impairment. However, 88% of individual level utilisation data were missing, and only 69.57% of Indigenous participants were correctly identified as Indigenous in NDIS data. In SEQ, Indigenous Australians demonstrated higher access to NDIS psychosocial support. Differences in access to and budget allocation of NDIS psychosocial support benefit those most in need. Nonetheless, systemic challenges remain including under-identification of Indigenous status, missing data on utilisation, and barriers associated with housing instability. Addressing these issues and strengthening culturally safe processes are critical to improving access to psychosocial disability support for Indigenous Australians.