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

SummaryMental 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.