Disparities in mental health service use in Australia: Analysis of the National Study of Mental Health and Wellbeing (2020–2022)

OBJECTIVES: We aimed to quantify inequalities in mental health service use in Australia and identify the sociodemographic, economic, and geographic factors associated with access. METHODS: We conducted a secondary analysis of the National Study of Mental Health and Wellbeing (NSMHWB, 2020-2022). We evaluated 12-month mental health service use before the survey among people who reported a mental disorder. We fitted multivariable logistic regression models adjusted for sociodemographic covariates and tested the joint (intersectional) effects of remoteness and socioeconomic area disadvantage on service use. Jackknife replicate weights accounted for the complex survey design. RESULTS: The study included 15,893 respondents (weighted population: 19,828,348). Lifetime prevalence of any mental health disorder was 42.9% (95% CI = [42.5, 43.3]), and 21.5% (95% CI = [20.7, 22.3]) reported symptoms in the past 12 months. Among those with a 12-month disorder, 45.2% (95% CI = [39.9, 50.5]) had accessed care, and 16.5% (95% CI = [15.8, 17.2]) reported using digital or telephone services. Service use was higher in university graduates and residents of advantaged areas and lower in remote/outer regional residents and the most disadvantaged quintiles. Intersectional analysis revealed compounded inequities, with the lowest service use observed among socioeconomically disadvantaged populations in remote areas and the highest among advantaged major-city residents. CONCLUSION: Substantial and intersecting inequalities exist in access to mental health services, with the lowest coverage among remote, socioeconomically disadvantaged, older, and male populations. Targeted, place-based strategies - including expanded outreach and tailored digital and community-based models - are needed to reduce unmet need and improve equity.