Built environment and Indigenous mental health service use: Evidence from Medicare microdata in South-East Queensland, Australia

This study provides a systematic exploration of whether neighbourhood-level built environment factors are associated with mental health service (MHS) utilisation by Indigenous peoples in South-East Queensland, Australia, while controlling for individual socio-demographic factors. Using population-based Medicare microdata linked with administrative records, we quantify individual-level MHS utilisation and employ multi-level negative binomial regression models to assess associations between MHS utilisation and environmental characteristics. Results indicate that built environment factors and their interactions with socio-demographic characteristics are statistically associated with Indigenous individuals' MHS utilisation. Specifically, greater MHS utilisation is associated with living in neighbourhoods with greater green space among younger individuals, and with living in inner regional areas (i.e., outskirts of major cities) among individuals with lower family incomes. Lower MHS utilisation is associated with living in neighbourhoods with greater green space among older individuals; with living in inner regional areas among those with higher incomes or two-family households; and with living in neighbourhoods with higher housing diversity among individuals with higher family incomes or three-or-more-family households. Furthermore, while overall lower MHS utilisation is associated with living in neighbourhoods with poorer public transit accessibility and residing in areas with better street network connectivity, these built environment conditions are associated with higher MHS utilisation among individuals needing assistance with daily living activities. These findings highlight a set of environmental attributes that merit deeper, community-led inquiry. As a cross-sectional observational analysis, this study identifies associations only—not causal evidence—offering an empirical starting point for future quasi-experimental and participatory research in partnership with Indigenous communities.