The first national mental health survey in Tokelau—part of a Pacific-wide study led by Professor Sir Collin Tukuitonga and Professor Jude McCool from the University of Auckland—wrapped up last week on 8 May.
Sir Collin said the people of Tokelau opened their hearts and minds to the research team with more than 300 completing the surveys. The Pacific Mental Health Survey Series was first launched in Sāmoa and Tonga two years ago, with findings revealing a notable prevalence of mental health distress.
“One might say these are not severe, but they are clearly affecting people—conditions such as anxiety, some of it related to climate change, depression, suicidal ideation, and thoughts of suicide. So, anxiety disorders and depression appear to be quite common,” says Sir Collin.
On the ground in Tokelau, clinical lead, Head of the Mental Health Unit in Sāmoa, psychiatrist Dr. George Tuitama, said it was the first time Tokelau had participated in a mental health awareness project.
“There was a high demand for us to attend various groups and deliver awareness talks. We did our best to meet these requests, as this is the first time Tokelau has experienced this kind of work,” he said.
The research also served as a mental health campaign, timely in the wake of a couple of youth suicides in 2022 and 2023, that struck at the heart of Tokelau’s small population of 1,600. Dr. Tuitama was able to hold direct audiences with youth in schools, offering expert information and support, while also engaging with teachers eager to be equipped to help vulnerable young people.
Presentations were delivered to Taupulega (local village councils), and training sessions held with clinicians and health staff across Tokelau’s three hospitals on the atolls of Atafu, Fakaofo, and Nukunonu, as well as with various community groups.
Funded by the Ministry of Foreign Affairs and Trade (MFAT) and Ministry of Health (MOH), Sir Collin noted that transporting a research team to Tokelau was no easy feat. Located 500 km north of Sāmoa and without an airport, Tokelau is accessible only by ferry via Sāmoa, with just two to three sailings a month. The journey takes 24–36 hours depending on sea conditions.
As well as Dr. Tuitama the research team included local study lead Dr. Lameka Sale and field researchers Randy Smith and Mafuli Tagataese Tana. Having previously conducted the survey in Sāmoa, they were able to build on their experiences for the people of Tokelau.
Project Manager, Dantzel Tiakia, said the project was initially delayed after the main ferry was out of service for several months in 2024. However, she said the time was used to ensure they were fully prepared before the team finally arrived in Fakaofo on 24 April.
Dr. Tuitama said they were told to expect a “hero’s welcome,” but were unprepared for the enthusiastic response from Tokelau locals. Word spread like wildfire, and requests poured in from Taupulega across the three atolls. Locals were curious why a team had traveled so far to discuss the often-overlooked topic of mental health.
“We had a meeting with Taupulega and gave a small presentation. They immediately saw the importance of mental health awareness and screening—they called a meeting for everyone to attend,” said Dr. Tuitama.
Tokelau health authorities also seized the opportunity to have a clinical expert like Dr. Tuitama visiting. Requests came from across the atolls, including visiting patients with acute mental health issues under 24-hour police monitoring, reviewing known mental health cases, and providing training for all health staff on Fakaofo.
On Nukunonu and Atafu, demand for presentations was equally high, with Taupulega requesting separate sessions for males (taulelea) and females (fatupaepae).
“I also had the chance to meet church leaders and the padre (patele) over Sāmoan kava. They asked if we could extend the sessions to schools and prepare another workshop specifically for youth. Young people are a high-risk group,” said Dr. Tuitama.
He added that teachers were especially eager to learn more about mental health and how to support at-risk students.
“People are beginning to understand that mental health is a vital part of overall health, and that it connects to every aspect of life. We’re doing our best to continue raising awareness. It’s encouraging—people are starting to talk about it and become more aware.”
He thanked Sir Collin and the team in Aotearoa New Zealand for supporting such important work, noting that the well-being of the team itself was also a priority.
“Thanks to good internet support, our team was able to stay connected with their families and avoid homesickness while we were in Tokelau,” said Dr. Tuitama.
Analysis of the data is expected in the coming months. Sir Collin emphasized that strong relationships played a key role in the high level of engagement between the research team and Tokelau locals.
“George and the team did great work in Sāmoa with the Mental Health Survey. They had limited time in Tokelau, so we needed people familiar with the survey, and a team that the people of Tokelau would trust. Sāmoa and Tokelau share cultural and linguistic similarities, which has been a great advantage.”
