Pacific Island Countries (PICs) face some of the most severe health risks from climate change, with associated mental health impacts that remain underrecognized. This scoping review synthesizes English-language peer-reviewed literature published by Feb 2025, to examine the mental health consequences of exposure to climate-related hazards across 22 PICs. The search identified 193 studies, of which 19 were included. Most studies employed qualitative or mixed methods, focusing on storms, droughts, sea-level rise, planned relocation, and environmental changes. Reported mental health outcomes included increased depression, anxiety, grief, and distress, often linked to direct exposure and secondary effects such as displacement, resource insecurity, and social disruption. Risk and protective factors emphasized broader social, cultural, spiritual, and environmental influences mediating the relationships between climate-sensitive hazard exposures and mental health outcomes in PICs. Cultural mediators such as traditional knowledge, land connection, and community cohesion shaped both vulnerability and resilience. Common coping strategies included relocation, community-based support, and leadership-driven actions. However, access to mental health care remained limited due to a shortage of trained professionals, stigma, and preference for traditional healing methods. To address these challenges, it is essential to integrate mental health into national public health frameworks, enhance disaster preparedness, increase access to mental health services, and conduct context-specific research.