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Mental health conditions are one of the most common causes of disability in the world. However, stigma and a lack of awareness still influence the rate of recognition and seeking care, not to mention recovery. Although much has been done in relation to urban and rural populations, semi-urban communities, settlements characterised by intermediate population density, mixed livelihoods, and limited specialist services, are underrepresented. The gap in this review is filled by looking at the role of awareness and stigma in semi-urban settings. The objectives were the knowledge and attitude level of mental health, discussion of the nature of the stigma that limits care, and synthesis of the qualitative data into the perceptions and experiences of the community members. A narrative mixed-methods synthesis of the published studies during 2015-2025 was carried out, including quantitative data on prevalence and determinants as well as thematic analysis of qualitative results. Findings indicate a peculiar situation of fake availability: semi-urban dwellers face half-baked access to the discourse of modern health but have no structural means to pursue it, generating ambivalence whereby illness is both medicalised and interpreted in supernatural or moral terms. Stigma was also affected by gender norms, generational differences, socioeconomic differences, media portrayals, and poor healthcare systems. The review offers a fresh conceptualization of semi-urban stigma as a hybrid category, and also identifies avenues towards school-based literacy, community involvement, and primary care integration of culturally sensitive and equitable mental health interventions.