Community Mental Health Service Teleconsultation Uptake and Crisis Relapse in Namibian Districts: A Difference-in-Differences Estimation

Namibian district mental health services face a persistent tension between centralised psychiatric capacity and the dispersed geography of crisis presentations, and teleconsultation has been promoted as a means of closing that gap without evidence from the settings where it is most needed. the present analysis specifies a difference-in-differences design for estimating the effect of district-level teleconsultation uptake on crisis relapse, using the DHS Program indicator 'Family planning messages at community meeting or event' (FP_EFPM_M_COM) as a community-engagement proxy across 15 African country surveys conducted between 2021 and 2025. The analytic sample comprises 15 country-survey observations with a mean of 29.733 and a standard deviation of 17.495, ranging from 6.60 in Mali to 73.40 in Malawi. It argues that the credibility of any teleconsultation effect estimate in this setting depends less on the choice of estimator than on the exogeneity of uptake timing, and it proposes a pre-registration template that makes that exogeneity auditable. The contribution is a transferable design protocol for community mental health service evaluation in low-resource districts, not a completed causal estimate.