Research gap exposed: Only 9 studies on tele-mental health for underserved populations in low-income countries

A team of researchers combed through four major academic databases looking for studies on remote mental health care in poor and middle-income countries. They found 754 articles. After screening titles, abstracts, and full texts, they ended up with nine. Nine studies. That small number itself tells you something: almost nobody has bothered to study whether delivering therapy by phone, video, or text actually works for the people who need it most.

The researchers, led by Sandra Jumbe and colleagues, published their findings in PLOS Digital Health in June 2026. They wanted to understand what stops people in rural and remote areas of low- and middle-income countries from using digital mental health services, and what helps them use it. The mental health crisis in these regions is severe. Eighty-two percent of people worldwide with diagnosable mental health conditions live in low- and middle-income countries, yet more than 90 percent of mental health resources are concentrated in wealthy nations. In many of these poorer countries, less than 1 percent of the total health budget goes to mental health. About 85 percent of people with mental health problems in these regions go untreated.

The nine studies the team analyzed included research from South-East Asia, Africa, the Eastern Mediterranean, and a few other regions, conducted between 2014 and 2022. Together they involved roughly 379 participants on average, ranging from studies with 17 people to one with 2,401. Most participants were women, which aligns with broader patterns showing women are more likely to seek mental health support. The studies examined various delivery methods: text messaging appeared in seven studies, video calls in six, and phone calls in five. Researchers looked at treatment for depression, substance use disorders, anxiety, and trauma.

What emerged from the analysis was a clear picture of obstacles and opportunities. On the barrier side, the most consistent problems were physical. Patients lacked their own phones or computers. They had to borrow devices, which meant they couldn't receive appointment reminders and their sessions got interrupted. Internet connections were unstable or nonexistent in six of the nine studies. In four studies, patients had no internet access at all or faced problems with mobile phone coverage that varied by location and time of day. Two studies noted that people couldn't keep their phones charged because electricity was unreliable. Beyond the hardware and connectivity issues, privacy was a major concern. Six studies reported that patients had nowhere private to take a call or video session at home. They feared being overheard, or family members objected to the mental health consultation, sometimes even preventing access to devices or monitoring sessions. Stigma around mental illness drove much of this fear. For providers, the barriers centered on knowledge and skill. They lacked training in how to deliver care remotely. They struggled without clear protocols or guidelines. The absence of visual cues during phone-only sessions made it harder to read patients and assess their conditions. Two studies mentioned that providers couldn't prescribe certain psychiatric medications online because of legal restrictions in their countries.

But the research also identified powerful facilitators. Both patients and providers consistently valued the time and cost savings. Remote care eliminated travel expenses and the time lost going to clinics, which mattered enormously in areas where distances were vast. It reduced overhead costs for providers too. Patients felt less burden from other responsibilities like finding childcare. When providers received information about how to use the technology and what to expect, confidence grew. When communities ran awareness programs about mental health and explained how tele-mental health worked and protected privacy, people became more willing to try it. Providers, across multiple studies, held positive attitudes toward remote care and recognized its benefits for patients. Many wanted training to get better at it. The therapeutic relationship could still form over the phone or video, studies showed. Consistency and punctuality from providers built trust and comfort.

The researchers used a theoretical framework called the COM-B model—Capability, Opportunity, and Motivation equals Behavior—to organize their findings. Infrastructure problems fell under opportunity barriers. Knowledge gaps and low literacy fell under capability. Stigma and privacy fears touched on motivation. The facilitators showed that when you gave people information, when you built in time and cost savings, when you had providers who believed in the approach, behavior shifted toward using the service.

The scoping review points toward concrete next steps. Governments need to invest in stable electricity, reliable internet, and affordable devices in rural areas. Community telehealth centers with good connectivity could serve as hubs. Partnerships with telecom companies to subsidize data costs and provide cheap phones could help. Training programs for providers need to cover not just technology but communication strategies and how to explain privacy protections to patients. Local guidelines adapted from WHO frameworks could give grassroots programs a foundation. The researchers emphasize that this is not just a public health issue but an economic one: untreated mental illness costs countries money through lost productivity, emergency room visits, and hospitalizations. Strategic investment in tele-mental health infrastructure could pay for itself while reaching people who otherwise have no access to care.