Research shows why access is only the beginning for First Nations mental health care

When it comes to mental health care, reaching a service is only one measure of access. What happens after that first contact matters too.

A QCMHR project bringing together four studies has examined how Aboriginal and Torres Strait Islander people in Southeast Queensland access and use mental health services and psychosocial supports, and what happens after people first connect with care.

The project found Aboriginal and Torres Strait Islander people in Southeast Queensland were more likely to access Medicare-subsidised mental health care than non-Indigenous people.

Associate Professor Sandra Diminic, co-investigator and Head of QCMHR’s Mental Health Services Research Stream, said the findings show that higher service use does not necessarily mean people are receiving the same care once they enter the system.

“What stands out is that Aboriginal and Torres Strait Islander people are reaching mental health services, but they are having fewer sessions, are less likely to receive psychotherapy and are waiting longer for follow-up care.”

The findings point to an important distinction. Access is not only about whether someone reaches a service, but what happens next. Do they receive the type of care they need? How long do they wait? And does that care work for them and their circumstances?

Access is only the beginning

Looking more closely at Medicare-subsidised mental health care revealed differences in both the type and timing of care Aboriginal and Torres Strait Islander people received.

They had fewer mental health service sessions overall, were less likely to receive psychotherapy and waited longer between receiving a mental health care plan and follow-up treatment.

“One of the important things these results show is that Aboriginal and Torres Strait Islander people are seeking and reaching services,” A/Prof Diminic said.

“The opportunity now is to look at what happens after that first contact and how we can make sure people receive the right type of support at the right time.”

Availability doesn’t always mean accessibility

Researchers found Aboriginal and Torres Strait Islander people were slightly less likely to use telehealth. Those who did were more likely to receive care by phone than video, less likely to receive psychotherapy and more likely to receive telehealth care only through a GP.

These differences were seen in Southeast Queensland, where most people live in non-remote areas. The findings suggest distance is only one part of access, with cost, service availability, technology and preferences also likely to shape how telehealth is used.

A/Prof Diminic said the findings show why telehealth needs to be designed around how people can and prefer to use it.

“Access is not just about whether a service exists. We also need to understand whether Aboriginal and Torres Strait Islander people can use it in a way that works for their circumstances and whether they feel comfortable doing so.”

Care can’t rely on “one-size-fits-all”

The research also makes clear there is no single experience of mental health care within Aboriginal and Torres Strait Islander communities.

Using data from the Queensland Urban Indigenous Mental Health Survey, also known as The Staying Deadly Survey, researchers examined the social, cultural and health factors associated with whether people sought help for their mental health.

For example, men experiencing high levels of psychological distress were less likely to use mental health services, while factors including physical health, social support, comorbidity and experiences of racism were also associated with service use.

Associate Professor Diminic said these differences matter because they show why improving mental health care cannot rely on a “one-size-fits-all” approach.

“Aboriginal and Torres Strait Islander communities are diverse. Understanding who is using services, who may be missing out and what is shaping those experiences can help us design care that responds to different people and different needs.”

“There isn’t one model of care that will work for everyone. Services need to be flexible enough to respond to people’s circumstances, preferences and the communities they are part of,” A/Prof Diminic said.

Circumstances can shape access

The project also explored access to psychosocial support through the National Disability Insurance Scheme (NDIS).

Despite national concerns about barriers to the NDIS for Aboriginal and Torres Strait Islander communities, Indigenous people in Southeast Queensland accessed NDIS psychosocial support at about twice the rate of non-Indigenous people.

But access was not the same for everyone. Aboriginal and Torres Strait Islander adults who had moved more than once during the year were less likely to access psychosocial support than those with stable housing, showing how circumstances outside the health system can affect whether people receive care.

The study also identified gaps in the information available about what happened after people entered the NDIS, including missing utilisation data and some participants not being correctly identified as Indigenous.

Associate Professor Diminic said stronger data is essential for understanding whether support is reaching people as intended.

“Good data helps to show where things are working well and where there are gaps. If we only measure whether someone entered a system, we can miss important parts of their experience.”

The system must work for people

The four studies show both where Aboriginal and Torres Strait Islander people are connecting with care and where services and systems need to respond differently.

The findings point to several areas where care could be strengthened, including quicker follow-ups, access to appropriate forms of therapy, different ways of receiving care and better information about who is receiving support.

They also reinforce that improving access means looking beyond individual choices and circumstances to the systems people are being asked to navigate.

Importantly, Indigenous perspectives helped shape the research from the beginning. Across the project, Aboriginal and Torres Strait Islander researchers, Elders, health providers and community representatives worked alongside clinicians, service providers, planners and other researchers to guide what was examined and how the findings were understood.

For the linked-data studies, this included a sense-making process that helped place the results in their cultural, social and service context. Rather than focusing on why individuals do or do not use services, the process helped researchers consider how systems and services could better respond to the people they are designed to support.

Improving access to mental health care is about much more than getting through the door. It is about making sure the next door opens too.

Established in 1987, QCMHR is funded by Queensland Health to work state-wide and contribute to the local, national, and global research efforts to improve mental health.

QCMHR acknowledges the Jagera, Yuggera, Ugarapul and Turrbal people as the Traditional Owners of the land on which QCMHR operates and their continuing connections to land, waters and community. We pay our respects to their Elders, past and present and stand together with all Aboriginal and Torres Strait Islander peoples.

We acknowledge people in our communities with lived experience of mental health, drug and alcohol concerns and those who care for them. We respect and value their generous contributions to our research.

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. Australian & New Zealand Journal of Psychiatry. https://doi.org/10.1177/00048674261476557

Disparities in the use of Medicare-subsidised telehealth mental health services by Aboriginal and Torres Strait Islander Australians in Southeast Queensland. Australian & New Zealand Journal of Psychiatry. https://doi.org/10.1177/00048674261470271

Predictors of health service use within an Indigenous Australian sample for issues related to their mental health: An analysis from the Queensland Urban Indigenous Mental Health Survey. Australian & New Zealand Journal of Psychiatry. https://doi.org/10.1177/00048674261471288

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. BMC Health Services Research, 25, 1488. https://doi.org/10.1186/s12913-025-13634-4  

Contact:

Associate Professor Sandra Diminic

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Media contact:

Laura Corcoran, Research Communications Officer

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