Mental health support grows beyond facility walls in Samoa

Green has become a global symbol of mental health awareness, hope and support. In Samoa, green balloons, ribbons, and awareness posters decorate the walls of the Ministry of Health’s Mental Health Unit at Tupua Tamasese Meaole (TTM) Hospital in Moto’otua, in recognition of World Mental Health Day. Across Apia at the Goshen Trust Mental Health Services in Vailima, the team is also recognizing Mental Health Day. Surrounded by lush trees and open grounds, the rehabilitation facility has provided reintegration and support services for people living with mental health conditions in Samoa since 2009.

Mental health is an essential part of overall health and well-being. Yet conversations with mental health practitioners inside both facilities revealed that stigma and misconceptions often delay help-seeking behaviour, leaving individuals and their families struggling to cope.

Confronting stigma and misconceptions

For Dr Epaggelia “Epa” Efu, Psychiatry Registrar with the Ministry of Health’s Mental Health Unit, stigma remains one of the biggest barriers to access to care.

“There is a lot of stigma and a lot of superstitious beliefs about mental health here in our country,” he shared.

The Mental Health Unit supports people with a range of conditions, from depression and anxiety to severe mental health conditions including psychosis and substance-related disorders. However, many people only seek help once their condition has significantly affected their daily lives, relationships or ability to function. Dr Epa said that some individuals first seek support through traditional pathways before approaching formal health services.

“By the time they present themselves here, it’s very late,” Dr Epa explained.

^{Psychiatry Registrar Epaggelia “Epa” Efu inside the Mental Health Unit at the Tupua Tamasese Meaole Hospital in Apia, Samoa. Photo © WHO / Faizza Tanggol}

Delayed help-seeking can make recovery more difficult and highlights the importance of awareness, early intervention and access to support.

At Goshen Trust Mental Health Services, Chief Executive Officer Afitu Naomi Eshraghi sees many of the same issues from a community perspective. She points to changing family structures, migration and increasing pressures on caregivers as challenges that can leave some families with fewer resources to support loved ones experiencing mental health conditions.

She believes stigma is also reinforced when society views mental illness as something affecting “other people” rather than recognizing that mental health is relevant to everyone.

“We tend to have the attitude of them and us,” Naomi observed. “They have it, we don’t have it.” 

Drawing strength from aiga and community

Despite these challenges, both practitioners view the strong family and community ties in Samoa as an asset when addressing mental health.

“Samoa is very special,” said Naomi. “It has a powerful gift to its people, and that’s family, or aiga.”

^{Afitu Naomi Eshraghi, Chief Executive Officer of Goshen Trust Mental Health Services, at the facility in Apia, Samoa. Photo © WHO / Faizza Tanggol}

Increasingly, mental health systems around the world are recognizing that recovery involves more than treatment alone. Family support, social connection, community participation and a sense of belonging all contribute to mental well-being and recovery. Dr Epa believes this aligns closely with Samoa’s culture and values.

“Mental health does not particularly belong to health alone,” said Dr Epa. “It belongs to everyone, it belongs to the church, it belongs to the community.”

He explained that communities are often the first to notice when someone is struggling. Isolation, loss of identity, ongoing stress and withdrawal from daily life can all be early warning signs. Strengthening community awareness can help people receive support earlier while also creating environments where individuals feel valued, connected and supported.

Rather than focusing solely on responding to crisis, efforts are increasingly centred on prevention, awareness, and supporting people where they live.

Supporting recovery beyond the clinic

The Ministry’s Mental Health Unit and Goshen Trust play different but complementary roles in Samoa’s mental health system. The Mental Health Unit provides clinical care, assessment, treatment, psychosocial support and community follow-up, while Goshen Trust focuses on rehabilitation and reintegration.

Both organizations work closely together, alongside other government and civil society partners, to support individuals and their families throughout the recovery process. Recovery often involves not just clinical treatment, but also rebuilding confidence, restoring family relationships, returning to work and reconnecting with community life.

The Ministry is increasing its emphasis on community-based approaches to build stronger support systems around people and communities who face mental health challenges.

The World Health Organization (WHO) has been supporting the Ministry of Health’s work for health, including through policy and planning advice and knowledge-sharing, as Samoa strengthens mental health services and community engagement efforts.

At Goshen, that work continues long after a person leaves hospital care. Staff work closely with families before someone returns home, helping prepare relatives for the transition and supporting the gradual rebuilding of trust and relationships. Naomi sees this as an extension of family and community values that have long existed within Samoa.

“We can go from having individual families to a community of families where everyone is looking after each other, caring, supporting one another,” she said.

Listening to lived experiences

As Samoa and the rest of the world mark World Mental Health Day 2026, the global theme, Lived experiences heard: real voices, real change, highlights the importance of ensuring that people with lived experience help shape the services, policies and support systems that affect their lives.

For mental health practitioners in Samoa, that message resonates strongly. People’s experiences can help identify gaps in services, highlight barriers to care, and provide important insights into what supports recovery.

Dr Epa said listening to people receiving care helps ensure support is tailored to their needs, values and circumstances.

“That’s why we try and hear from their voices, hear from what they mean, so that we’ll be able to make that change and support them in any way that we can,” Dr Epa explained.

Naomi agrees that people with lived experience have perspectives that professionals or advocates cannot fully replace. Their experiences can help shape future services and ensure mental health systems remain responsive to those they serve.

“It still is about the person who is going through it,” she said. “Any policy, regulation, or law needs their voice because they are the ones who have known what worked, they have known the darkness of it, and they have known how to get out of it.”

^{Afitu Naomi Eshraghi (centre), Chief Executive Officer of Goshen Trust Mental Health Services, with a staff member and service user during an activity session at the Goshen Trust facility in Apia. Photo © WHO / Faizza Tanggol}

A reason for hope

Both practitioners acknowledge that reducing stigma and improving access to support will take time, but they are already seeing positive changes.

Communities are increasingly requesting mental health information and awareness sessions. More conversations are taking place within families, churches and villages. Partnerships between government, civil society organizations, and community groups continue to strengthen.

For anyone in Samoa struggling with their mental health, the closing message that the practitioners shared was simple.

“If you’re dealing with any mental health struggles, you’re not alone in this fight and you don’t need to deal with this alone as well,” said Dr Epa. “There are a lot of people that are willing to support and help you.”

“Mental illness is not you. You are not the diagnosis,” Naomi shared. “There’s a story about you. You have a life. You have a family. You’re able to love again, work again. So yes, we are here.”

^{Staff members of the Ministry of Health's Mental Health Unit pose for a group photo at Tupua Tamasese Meaole Hospital in Moto'otua. The team provides assessment, treatment, and ongoing support for people living with mental health conditions and their families. Photo © WHO / Faizza Tanggol}