Ethical issues in digital mental health delivery: a comprehensive scoping review of global challenges

Abstract

Digital technologies are becoming increasingly integrated into mental health counselling. While expanding the boundaries of service provision, these technologies have also raised numerous ethical challenges that urgently need clarification. This study conducts a scoping review following the standardized methodology developed by Arksey and O’Malley. It identifies five core ethical challenges facing practitioners: privacy and data security; informed consent and autonomy; service accessibility and equality; algorithmic fairness and bias mitigation; and inclusiveness and equity. Existing comparative analyses show that Western countries, including the United States (US) and the United Kingdom (UK), have mature digital mental health regulatory frameworks. In contrast, non-Western countries generally face gaps in legal protections, which have created a global ethical divide. Artificial intelligence (AI)-related risks, such as algorithmic bias and lack of transparency, further exacerbate these problems. The study calls on policymakers to improve relevant regulatory frameworks and requires practitioners to receive specialized ethical training.