Despite progress, poor performance of Pacific Island health systems continues to be highlighted by treatment gaps. Projecting burden of disease and the human resource requirements for mental health services will help appropriately plan for mental health in the region. We drew upon burden of disease and population data to estimate disability-associated burden of disease from 2010 to 2050 for the Pacific region. Packages of care for low and middle income countries provided a method for estimating mental health staffing requirements. Gaps between estimated target and current staffing levels were estimated. Holding prevalence rates constant over time would see a 74 per cent increase in disability-related burden for mental disorders. Projected increases in workforce requirements over the 2010–2050 period are large. Preparation for the increasing burden of mental disorders into the future is essential. A sustained, collaborative approach must be secured to achieve improvements in mental health services and treatment coverage.