Towards equity in Aboriginal and Torres Strait Islander mental health: Policy priorities across Medicare, telehealth and the National Disability Insurance Scheme

The objective of this Viewpoint is to synthesise our recently published findings on disparities in mental health service use among Indigenous Australians and explore implications for equitable service delivery across Medicare, telehealth and the National Disability Insurance Scheme. This viewpoint summarises findings from linked data analyses across three studies examining mental health service use across Medicare, telehealth and the National Disability Insurance Scheme psychosocial supports among Indigenous Australians in Southeast Queensland. In these studies, key sociodemographic and service predictors were examined to identify gaps in service use. Despite a higher proportion of Indigenous Australians using any Medicare-subsidised mental health services, Indigenous Australians were more likely to use general practitioners and phone-based services and less likely to use psychologists and psychological therapies as compared with non-Indigenous Australians. A substantial proportion had no follow-up after care plans, and long delays were common. Smaller proportions of Indigenous Medicare mental health service users used telehealth. Access to telehealth increased service use among both Indigenous and non-Indigenous Australians; however, there is still a service gap. In the National Disability Insurance Scheme psychosocial support, access was more common in individuals with psychotic disorders, with underrepresentation of other mental health conditions, and those with unstable housing had lower access rates. These findings highlight persistent inequities in Commonwealth-funded specialised mental health care access for Indigenous Australians. Policymakers should prioritise reforms to strengthen the cultural safety and accessibility of federally administered schemes such as the Medicare and the National Disability Insurance Scheme. Service planners and commissioners can address system gaps by commissioning culturally safe service-navigation supports and alternative pathways to psychological therapies.