While the Pacific region stands at the forefront of climate change related impacts, we need to hear from those most affected especially in terms of the mental health and wellbeing impacts for our Pacific communities. This exploratory study is led and carried out by Pacific and Indigenous researchers with Pacific peoples and seeks to place Pacific voices front and centre of its practice and analysis. This multi-country study was undertaken with Pacific experts and knowledge holders in Aotearoa New Zealand, the Cook Islands and Niue. This paper foregrounds Pacific perspectives, and considers how western concepts, such as eco- and climate anxiety, can be best applied to understand the mental distress of climate change for Pacific peoples. We demonstrate that there is a deep interconnection between climate change and mental health and wellbeing, and the impacts of this link has been cultural nuanced and defined by and for Pacific peoples.