Telehealth and In-Person Mental Health Care for Underserved Populations: A Narrative Scoping Synthesis

Abstract

Background: Mental health disparities disproportionately affect rural, low-income, and racially marginalized communities. Telehealth has emerged as a potentially important modality for expanding access to mental health care, yet comparative evidence on its clinical effectiveness, engagement outcomes, and equity implications relative to in-person care remains limited and heterogeneous.

Methods: A narrative scoping synthesis was conducted following PRISMA 2020 guidelines. PubMed and Scopus were searched through December 2024 using predefined keywords. The evidence base comprised primary comparative studies, systematic reviews, a rapid review, and a qualitative scoping review. Only English-language publications were eligible, introducing potential selection bias. Single-reviewer screening and extraction were performed, no protocol was pre-registered, and no formal risk-of-bias assessment was conducted—all acknowledged methodological limitations.

Results: Eight sources meeting inclusion criteria were identified, representing approximately 14,000 participants across diverse underserved settings; several included sources are review-level syntheses and should be interpreted accordingly. Evidence suggests broadly comparable clinical outcomes between telehealth and in-person care for depression, anxiety, and PTSD in some underserved settings, though findings are context-dependent and methodologically limited. Appointment adherence findings were mixed. Technology access, language barriers, and provider cultural competency gaps were consistently identified as equity-relevant concerns.

Conclusions: Available evidence suggests telehealth may offer broadly comparable outcomes to in-person mental health care in some underserved settings, though this conclusion derives from a heterogeneous, methodologically limited evidence base and should be interpreted with caution. Equity effects remain context-specific and conditional on structural supports. High-quality prospective trials with equity-centered outcome frameworks are needed.