Admission to Fiji’s sole psychiatric hospital St Giles attaches the stigma of mental illness to patients, which may impact on the course of their lives and on their social acceptability. We argue that alternatives to hospitalization are health promoting in that they avoid stigmatization and institutional dependency. Recommendations are proposed for the further development of a community-based mental health service, such that admission is avoided where possible and where services are provided in the least restrictive environment close to patient’s family and community supports.