BACKGROUND Part of the quality of a mental health service is the degree in which the service can demonstrate that its output is aligned with indicators of population need. AIM To investigate to what degree small areas in the Netherlands (pc3-level, 798 areas) differ in the level of mental health care consumption; to what degree this is reducible to demographic and socioeconomic indicators representing known predictors of population mental health needs; and to what degree associations between indicators of need and mental health consumption vary across regions. METHOD Analysis of public mental health cost data in the Netherlands over de period 2011-2017 for the age group 18-65 years. RESULTS Mental health care costs displayed a pattern of small area variation that for 77% was reducible to socioeconomic and demographic factors at the regional level. Mental health care costs were associated independently with younger age, female sex and a range of socioeconomic factors including urbanicity, ethnic density and a socioeconomic index variable. However, the degree to which these indicators of mental health needs impacted mental health costs varied from region to region. CONCLUSION Regional mental health care output in the Netherlands is partially aligned with population needs These analyses validate the notion that mental health care commissioning may be guided by benchmarked evidence of service output being proportional to the needs predicted by population socioeconomic indices.