Telepsychiatry and Rural Mental Health Access in U.S. Health Care: An Integrative Review of Appointment Access, Utilization, and Care Continuity.

BACKGROUND: Rural mental health care access in the United States (U.S.) has remained limited because of psychiatrist shortages, geographic isolation, transportation barriers, and long appointment wait times. Sixty-five percent of nonmetropolitan counties lack a practicing psychiatrist, rising to 80% in the most remote noncore counties. The objective of this work was to evaluate whether telepsychiatry was associated with appointment access, health care utilization, appointment completion, and continuity of care among rural U.S. populations between 2015 and 2026. METHODS: An integrative review was conducted using a structured Population, Intervention, Comparison, and Outcome question framework and Preferred Reporting Items for Systematic Reviews and Meta-Analyses-informed methodology. Searches were conducted from August 2025 through August 2026 in PubMed, Cumulative Index to Nursing and Allied Health Literature, Psychological Information Database, Scopus, and Web of Science, supplemented by Google Scholar and by governmental and professional sources. Sixty sources met eligibility criteria across empirical, review, policy, and economic evidence types. RESULTS: Telepsychiatry was associated with faster access to care. Median wait times were 43 days for telepsychiatry versus 67 days for in-person care, and emergency consultation turnaround was 84% shorter. Rural use of any mental health care rose from 9.35% in 2019 to 13.07% in 2023, though nonrural use rose faster. Appointment completion findings were mixed, with lower missed-appointment rates but higher rates in one rural behavioral health population. Telepsychiatry use was associated with a lower hospitalization rate in a Medicaid population. CONCLUSIONS: Telepsychiatry was associated with faster psychiatric access and with more favorable continuity outcomes in several rural and underserved populations, while appointment-completion findings were inconsistent across rural settings.