Explaining Policy Change in Samoa’s Mental Health System

Modern mental health systems are the products of successive waves of policy development and adaptation. This is particularly so in many low to middle income countries that inherited colonial mental health laws, and institutions often followed by legislative shifts at independence. But how otherwise do these systems change? And why do these systems change? This article applies historical institutionalism to consider policy change over time, in a single case study of a small island state, Samoa. In doing so, the article will consider three discrete policy change episodes to argue that national policy change in the area of mental health has been the result of foreign direction or influence. These three critical change events occurred leading to policy change: colonisation, independence and the intervention of an intergovernmental organisation. These findings are instructive for future, domestically-driven policy change initiatives, in providing the importance of historical policy development and the continuing importance of international policy advocates in promoting policy change.