Assessing mental health needs in Pacific countries

The Pacific Mental Health Surveys project is funded by the Polynesian Health Corridors programme established by the Ministry of Foreign Affairs and Trade in conjunction with the Ministry of Health. The National Institute for Health Innovation (NIHI) is providing project management and data management support.

“Pacific people have managed their wellbeing and mental health on their own or with the help of their family, churches or the village,” said Sir Collin Tukuitonga, who is co-leading the project. “However, for many years, those of us who work in health have recognised that we don’t know well enough the extent and nature of mental health disorders around the region. We are working to change that.”

In addition to Tukuitonga, who is Associate Dean Pacific and Associate Professor of Public Health in the Faculty of Medical and Health Sciences, the project is co-led by Associate Professor Judith McCool, head of the Department of Epidemiology and Biostatistics, and Dr Roannie Ng Shiu, Pacific Health Research Programme manager for the Office of the Associate Dean Pacific. Nalei Taufa is the New Zealand project manager.

“The resilience and the collective strength of Pacific Island regions and communities are evident as they deal with Covid-19 and the climate crisis, but these complex and rapidly evolving issues are expected to exacerbate mental health distress among Pacific Island communities,” said McCool. “The limited epidemiological evidence and anecdotes to date have suggested a rise in the rates of mental health distress, disorders and suicides in the region.”

While there have been previous attempts to understand the mental health burden in the Pacific, these have been limited in scale and follow-up has not been appropriately tailored to the culture and lived experiences of the communities, the researchers say.

“Take someone who is hearing voices,” said Tukuitonga. “In a traditional medical setting, if you say you’re hearing voices in your head, the doctor will say you have schizophrenia. However, in many of the islands, hearing voices, particularly of your ancestors, is a well-recognised cultural phenomenon because it’s seen as quite normal to continue to live with those who have passed away. That’s an example of why getting cultural bearings on mental disorders is important.”

In addition to gathering evidence on mental health disorders, the project will review existing policies and identify workforce capacity needs. To do this, the project team will work closely with each country’s government and workforce.

The project will be co-designed with Pacific health and research professionals so project ownership can be fully transferred to Pacific countries after an initial period of working together. Ultimately, the goal is to develop country-led, sustainable responses to mental health disorders while growing local capability and capacity in the process.

“The Pacific Mental Health Surveys project is about building a better knowledge base from which we can then advocate for better services,” says Taufa. “By carrying out toli or fieldwork in-country, it helps create safe spaces for people to talk about mental health, which can hopefully lead to normalising or initiating talanoa around mental health and its challenges.”

The project will start in Samoa and then expand to Tonga and Tuvalu. Key partners in Samoa include Seiulialii Dr George Tuitama, the country’s only psychiatrist, who will be the Samoan co-investigator, and Muliagatele Dr Potoae Roberts-Aiafi, the Samoan coordinator, who is recruiting more personnel including interviewers. Ng Shiu will act as a bridge between the New Zealand and Samoa partners.

On-the-ground research is expected to start in Samoa late this year or in early 2023. Data will be stored both in New Zealand and the project countries so that in-country partners can access and analyse the data. To uphold Pacific data sovereignty, there will be an emphasis on data sharing that allows Pacific countries to derive value, such as health gains, from their own data.

“Nothing is really about Pacific people if it’s not created by Pacific people,” says Taufa. “This project will reflect that from conceptualisation all the way through to dissemination.”