The species is divided into two relatively weakly differentiated varieties, Psychotria holtzii (K. Schum.) E.M.A. Petit var. holtzii and var. pubescens Verdc. Because 22 of the 36 collections of this species have not been identified to variety, assessment of the individual varieties is delayed pending further specimen identification and a decision as to the taxonomic value of the varieties.

Psychotria holtzii is known from 36 herbarium specimens representing 28 unique occurrences collected between 1901 and 2002. Based on these occurrences, the calculated extent of occurrence (EOO) is 45,756 km², well above the threshold values for Vulnerable under the B1 criterion, and the area of occupancy (AOO) is 112 km², within the threshold values for Endangered under the B2 criterion. Twenty one locations may be defined with respect to the principal threats of agricultural clearing, charcoal burning, and urbanization: 1) the three northern-most, unprotected Kenyan occurrences at Mangea; 2) the single unprotected occurrence just northeast of Shimba Hills National Reserve; 3) the two occurrences within Shimba Hills National Reserve; 4) the four unprotected occurrences near Gongoni and Buda Mafisini Forest Reserves; 5) the single occurrence within Manga Forest Reserve; 6) the single occurrence within Msumbugwe Forest Reserve; 7) the single occurrence within Ngezi-Vumbawimbi Forest Reserve on Pemba Island; 8) the single occurrence within Pande Game Reserve; 9) the single unprotected occurrence 26 km west of Dar es Salaam on the Morogoro road; 10) the single unprotected occurrence near Kibaha; 11) the single unprotected occurrence between Pugu-Kazimzumbwi Nature Forest Reserve and Ruvu South Forest Reserve; 12) the three occurrences within Pugu-Kazimzumbwi Nature Forest Reserve and Ruvu South Forest Reserve; 13) the single occurrence at Gongolamboto Cemetery Copse near Dar es Salaam; 14) the single unprotected occurrence at Mogo Forest [Sachsenwald] in Dar es Salaam (probably extirpated); 15) the single unprotected occurrence 21 km south of Dar es Salaam on road to Kilwa; 16) the single unprotected occurrence at Kisiju in Mkuranga District, Tanzania; 17) the single unprotected occurrence in Rufiji District just north of Ruhoi River Forest Reserve and east of Ngulakula Forest Reserve; 19) the single unprotected occurrence on Mafia Island; 20) the single unprotected occurrence just south of Namakutwa/Namade Forest Reserve; and 21) the single occurrence within Kiwengoma Forest Reserve. Given the large number of locations, well in excess of 10, the threshold for VU under the B2 criterion and the occurrence of the species in a number of well-protected sites, it is currently assessed as Least Concern (LC). If further surveys show that it no longer exists in a number of these places, a reduced number of locations could change the assessment to Near Threatened (NT) or even Vulnerable (VU).

This species is found in Kenya and Tanzania at elevations of 6–500 m asl (Verdcourt 1976).

There is no information is available on population size, density, or decline.

The species is a shrub of coastal evergreen forest and dry riverine thicket.

Psychotria holtzii is a species of coastal habitats that are  subject to degradation and destruction due to human activities including smallholder agriculture, charcoal burning, and urbanisation. In Kenya, its two occurrences within the well-protected Shimba Hills National Reserve are likely to be secure, but all other Kenyan occurrences lie outside the protected area network and are subject to agricultural disturbance and/or charcoal burning. In Tanzania, occurrences in Manga, Msumbugwe, and Ngezi-Vumbawimbi Forest Reserves and Pande Game Reserve are relatively secure. The species has been reported from all three parcels of Pugu-Kazimzumbwi Nature Forest Reserve (the former Pugu, Kazimzumbwi, and Vikindu Forest Reserves), all of which were badly degraded prior to the declaraton of the Nature Reserve in 2020 (Government of Tanzania 2020). Although these areas now enjoy the highest level of protection afforded by the Government of Tanzania (Tanzania Forest Conservation Group 2017), the species has not been collected there since 1991 (Frontier-Tanzania 1762, MO), 29 years before effective legal protection began; a targeted botanical survey of the Nature Reserve is needed to ascertain if P. holtzii has survived there. The southernmost occurrence of the species is at Kiwengoma Forest, part of the Rufiji District Key Biodiversity Area and said to be in “reasonable condition” (Key Biodiversity Areas Partnership 2023), but recent reports indicate otherwise, with much clearance and burning.

No uses are reported.

No ex situ or in situ conservation actions are known to be in place. The species is known from the Shimba Hills National Reserve (2 occurrences), Manga Forest Reserve, Msumbugwe Forest Reserve, Ngezi-Vumbawimbi Forest Reserve, Pande Game Reserve, Pugu-Kazimzumbwi Nature Forest Reserve (3 occurrences), and Kiwengoma Forest Reserve.