Less than half included questions about interventions received, hospital admissions or treatment dropout.
Indigenous-specific content was most common in questions regarding use of support services or self-management, types of health professionals consulted, barriers to care and interventions received.
It comprised a systematic review of existing syntheses of the literature to identify relevant surveys and focused web searches to identify additional surveys.
We considered that a rapid review strategy would identify the relevant surveys given that community representative surveys are large, visible undertakings that would have been published or described in the public domain.
In addition to mainstream mental health services, each of these countries funds public programmes to deliver mental health services specifically for Indigenous people such as the Indian Health Service in the United States [Universal public medical insurance programme that plans and funds (mainly private) provision, administered separately by each province/territory ~67% buy complementary coverage for non-covered benefits Medicare provides insurance for those aged 65 and older, some disabled; Medicaid provides insurance for low-income; for those without employer coverage, state-level insurance exchanges exist with income-based subsidies ~66% of population is covered by primary private voluntary insurance (employer-based and individual)Largely administered by mainstream organisations; some care is provided by the National Aboriginal Community Controlled Organisation, a network of independent local health services owned and run by local Aboriginal and Torres Strait Islander communities Through the First Nations and Inuit Health Branch, the federal government delivers certain mental health services and funds non-insured health benefits (including counselling) to eligible First Nations and Inuit communities The federal government fully funds health services, including mental health services, for Native Americans and Alaska Natives through a combination of Medicaid and care delivered by the Indian Health Service The higher Indigenous burden likely results, at least in part, from inadequate treatment, unmet needs, and barriers to receiving appropriate and effective mental healthcare.
These advances have enabled the quality of care being delivered to be estimated and individual treatment preferences to be identified, in turn highlighting possible service system deficiencies.
Even if they did include samples of sufficient size, question content may not acknowledge specialty Indigenous health services and interventions available or relevant for Indigenous people, such as traditional healers and culture-based interventions .
While some reports from Indigenous surveys have described aspects of service utilisation, these vary widely in scope and there is limited standardisation of the aspects of service use ascertained.
Epidemiological surveys measuring service use for mental health among Indigenous populations have been less comprehensive and less standardised than surveys of the general population, despite having assessed similar content.
To better understand the gaps in mental health service systems for Indigenous people, systematically-collected subjective and objective indicators of the quality of care being delivered are needed.
For example, by comparing actual treatment delivered with recommendations from evidence-based treatment guidelines, epidemiological survey data has revealed disparities in rates of ‘minimally adequate treatment’ received by different racial or ethnic subpopulations .