Mental health systems in Pacific island countries and territories: a scoping review of current evidence

Jialing Lin; Xinrui Wei; Peixin Han; Tinghsuan Hsu; Jiaying Sun; Carey Marr; Rong Liu; Rohina Joshi; Minh Cuong Duong; Odille Chang; Xiwen Qin; Jinfeng Ding; Christine Y Lu; Patricia M Davidson; Michael Kidd

doi:10.1016/j.lanwpc.2026.101856

Mental health systems in Pacific island countries and territories: a scoping review of current evidence

Lancet Reg Health West Pac. 2026 Apr 16:69:101856. doi: 10.1016/j.lanwpc.2026.101856. eCollection 2026 Apr.

Authors

Jialing Lin¹, Xinrui Wei^{1

2}, Peixin Han³, Tinghsuan Hsu⁴, Jiaying Sun⁵, Carey Marr⁶, Rong Liu^{7

8}, Rohina Joshi^{9

10}, Minh Cuong Duong⁹, Odille Chang¹¹, Xiwen Qin^{12

13}, Jinfeng Ding^{13

14}, Christine Y Lu^{15

16}, Patricia M Davidson¹, Michael Kidd^{1

17

18

19}

Affiliations

¹ International Centre for Future Health Systems, University of New South Wales, Sydney, New South Wales, Australia.
² China General Practice of Department, Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China.
³ Faculty of Science and Technology, Beijing Normal-Hong Kong Baptist University, Zhuhai, Guangdong, China.
⁴ Global Business School for Health, University College London, London, United Kingdom.
⁵ University of California, San Diego, La Jolla, CA, USA.
⁶ Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia.
⁷ Centre for Infectious Diseases and Microbiology - Public Health, Westmead Hospital, Westmead, New South Wales, Australia.
⁸ Sydney Infectious Diseases Institute (Sydney ID), Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
⁹ School of Population Health, University of New South Wales, Sydney, New South Wales, Australia.
¹⁰ The George Institute for Global Health, UNSW, Sydney, Australia.
¹¹ Fiji National University, Suva, Fiji.
¹² Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, Guangdong, China.
¹³ School of Global and Population Health, The University of Western Australia, Perth, WA, Australia.
¹⁴ Xiangya School of Nursing, Central South University, Changsha, Hunan, China.
¹⁵ School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, 2006, Australia.
¹⁶ Kolling Institute, The University of Sydney Faculty of Medicine and Health and the Northern Sydney Local Health District, Sydney, New South Wales, Australia.
¹⁷ Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom.
¹⁸ College of Health & Medicine, Australian National University, Canberra, Australia.
¹⁹ Department of Family and Community Medicine, University of Toronto, Canada.

Abstract

Mental health systems are a critical component of health system performance in Pacific island countries and territories (PICTs), yet evidence remains uneven across settings. This scoping review mapped available evidence on mental health system performance in each PICT using the WHO Health System Building Blocks framework. We searched nine peer-reviewed databases and 13 grey literature sources (2015-2025). Of the 23,574 records identified, 91 studies were included, covering most PICTs. Most studies covered service delivery (n = 84), governance (n = 81), and workforce (n = 79). Findings revealed that systems remain predominantly hospital-centred with severe workforce shortages, limited financing, weak information systems, and fragile access to essential medicines. Although most PICTs have mental health policies, implementation capacity is constrained and fragmented. Some community-based and culturally embedded models exist, but are often poorly integrated into formal systems. Strengthening mental health systems in PICTs requires country-specific, system-wide reforms to address persistent inequities and enhance resilience against climate-related emergencies.

Keywords: Health system performance; Leadership; Mental health systems; Pacific island countries and territories; Scoping review; Service delivery; Workforce.

Publication types

Review