Harnessing Pasifika perspectives in mental health care

Mental health has historically been understood through Western frameworks that emphasise individual illness, symptoms, and clinical treatment. However, these frameworks do not accurately capture the ways in which diverse cultural groups understand and experience mental health. For Pacific peoples, whose worldviews are inherently collective and relational, mental health is often understood across holistic frameworks that view an individual as a whole – the whole being everything about them and everything they belong to.

Recent research shows Pacific adults experience psychological distress at rates almost 1.5 times higher than non-Pacific peoples, yet Pacific communities remain significantly underserved by our mental health system. We also know that Pacific peoples in Aotearoa New Zealand are less likely to access mainstream mental health services, often because of cultural stigma, systemic barriers, and a lack of culturally safe and responsive care. This highlights a critical gap in our mental health system.

In our recent study published in the Journal of the Royal Society of New Zealand, we surveyed 548 Pacific peoples aged 16 to 83 across Aotearoa New Zealand. Participants were asked what they thought depression was, how best to respond to it, and what kinds of support they considered helpful or harmful.

Participant descriptions of depression aligned with clinical diagnostic criteria with responses that recognised the low mood, the loss of motivation, the withdrawal from life. But when we asked what someone experiencing depression should do, the overwhelming response wasn’t “see a doctor” or “call a counsellor”. It was, “talk to your siblings”, “connect with your church community”, “reach out to a family member”, “speak to someone you trust”.

Participants were also asked to rate the helpfulness and harm of various actions in response to depression, and the results were unequivocal; using drugs or alcohol were overwhelmingly seen as harmful. Even drinking kava – a traditional Pacific non-alcoholic beverage – was seen as harmful by most participants.

Our research also shows that Pacific peoples recognise the value of counsellors, psychiatrists, and clinical expertise. They’re just telling us that healing can’t happen in isolation. Clinical care needs to work alongside – not instead of – the informal support systems that have sustained Pacific communities for generations.

What can our mental health services do to best support Pacific peoples? We need to recognise that Pacific peoples place deep value on the interconnectedness of culture, family, community, and spirituality. The concept of vā – the sacred space that exists between people, places, and spaces – emphasises the importance of maintaining harmony and balance within relationships. In this way, diagnosis and treatment that focuses on the individual can feel unnatural.

When services and approaches are grounded in Pacific values and delivered in culturally safe and responsive ways, it provides a more inviting and effective pathway for Pacific peoples to engage with mental health services. One that acknowledges Pacific peoples’ strengths, respects Pacific ways of knowing and being, and supports healing within the family.

Despite the centrality of family and collective wellbeing in Pacific worldviews, most mental health services are grounded in Western, individualistic models, contributing to Pacific disengagement and dissatisfaction. Pesetā Dr Veronica Tone-Graham, a clinical psychologist, researcher and colleague at the University of Auckland recognises this and was recently awarded a Pacific Health Research Postdoctoral Fellowship from the Health Research Council to explore the efficacy of family therapy for Pacific peoples. By working alongside Pacific families, clinicians, and community stakeholders, the research will develop a framework for family therapy that will inform clinical practice and policy, contributing to a more responsive and equitable mental health service.

The pathway forward doesn’t have to be complicated, but it requires humility. We need clinicians trained not just in cultural competency tick-boxes, but in genuinely engaging with Pacific models of wellbeing.

We need to fund Pacific-led community initiatives that are already doing this work on shoestring budgets. We need mental health services that welcome families into the room, that respect spiritual dimensions of healing, and that see churches and community leaders as partners in care. We need policy that embeds Pacific perspectives from the beginning, not as an afterthought. Te Mana Ola, New Zealand’s first Pacific Health Strategy, sets the direction for achieving equity over the next decade. But strategy without properly resourced, Pacific-led implementation is just words on paper.