TABLE 4.

Representative quotes of each category of analysis by stakeholders’ group (Metropolitan area of Guadalajara, Mexico. 2023).

Category/Subcategory	Group	Representative testimony
Stigma and discrimination	Decision maker/Woman from SNE, 36 years old	“The word schizophrenia or bipolarity or issues like that, people think, they see it as very intense, like someone who might have a breakdown at work, so, they shut down.”
	Clinic manager/Woman, head of dept. At SALME	“The stigma that exists, besides that, is the ignorance that exists on the part of companies to be able to hire a person who can perform their activities regardless of whether they have an SMI.”
	Provider/Male psychiatrist	“We find more intolerance and outright rejection by companies supposedly socially responsible 1 .”
	User/Woman diagnosed with SMI; 38 years old	“I didn't feel entitled sometimes to ask for leave because the schedule was very strict, or the time they deducted, the delays, and all that.”
Limitations in SMI care
Imbalanced focus	Decision maker/Woman, director of civic participation	“There is a lack of a comprehensive health focus in the economic, housing, access to education, transportation sectors. I don’t know how this vision is with all the social determinants of health, to be able to prevent and then not require so much attention in health services.”
	Clinic manager/Man, director at SALME	“What matters to the health system is that people are not hospitalized, that they are moderately stable, and then the counterpart or what comes after that reduction in hospitalization rates, like how the person’s functionality is not within public policies, there is no link.”
	Provider/Male psychiatrist	“It’s a farm-like recovery model for mental problems and it’s a typical asylum hospital, emblematic of México’s public health policy.”
Lack of resources	Decision maker/Man, SM coordinator	“The big problem in public service is, has been, and will continue to be resources, the money.”
	Organizational/Director at SALME	“Among the main limitations are also human resources to complete the basic staff and those that cover incidents, but also to cover different shifts: Afternoon, night, weekends, with the whole staff including base psychiatrists, base general doctors, base social workers. Another limitation is the management of financial resources.”
	Provider/Female psychologist	“It also does not depend on us as workers, but on more political issues that also often create conflicts by not having all the resources.”
Lack of knowledge	Decision maker/Woman from SNE, 36 years old	“I know there are laws that prohibit discrimination, including the rights to work, to a dignified life, etc. I mean, yes, there are laws for that, but I don’t know if there are any specific norms towards mental disorders.”
​	Organizational/Director at SALME	“It happens to be difficult for a social worker, or a doctor, a psychologist, to be hugely or deeply immersed in these topics and to be able to give timely and effective follow-up.”
	Provider/Female nurse	“Most jobs, there is no recognition that the patient is feeling bad.”
Patient-related issues	Decision maker/Man, labor inclusion	“Honesty, both the family of the person and the person themselves; they do have to inform the companies what psychopharmacology, what therapy, what assistance, what specific needs they have.”
	Clinic manager/Director at SALME	“We have to work a lot with them so that they learn to be responsible, learn to tolerate frustration when something goes wrong or they are scolded, so that they don't quit at the first hurdle.”
	Provider/Female nurse	“Because of their own condition, they may not have had an average education. Many do not have secondary education, many did not finish high school, almost none have a college degree, so this poses an initial barrier to job options.”
	User/Woman diagnosed with SMI; 38 years old	“The fact of rotating shifts does not favor me much in the way that sleep is very important to me to avoid relapses. So, the time I had to rotate shifts, I couldn't handle it. I mean, I had to leave the job.”
Support network issues	Decision maker/Woman from SNE	“It’s everything: The side effects of the medications, obviously also from the diagnosis of the person, from the family, from the support they have, from the environment they are in.”
	Clinic manager/Man, sub-director at SALME	“A significant limitation I see is the lack of a support network, in fact, many times the lack of a family support network.”
	Provider/Female social worker	“We have come across relatives who are not aware that they have a disease. So, when there is no awareness of the disease, there is no support point for the patient to continue rehabilitating, basically, we have seen that the rejection is from the family itself.”
Legislative difficulties	Decision maker/Woman director of citizen participation	“The results of the initial law were not entirely good, it was not very clear how the best strategies for patient care were going to be outlined, a fully well-elaborated law was not generated, and there have been other attempts, in fact, recently there was an initiative by some political parties for the modification of the law… but we still do not have a national diagnosis, or a state diagnosis, from which the best policy strategies would have to start.”
	Clinic manager/Man, sub-director at SALME	“There are many interventions that have to be done that go beyond the health sector, the economic sector, the social sector, even the legal sector has to be involved.”
	Provider/Female psychologist	“The legal part, for example, needs to be addressed that it is not breaking a patient’s right.”
Facilitators
Scope of strategies	Decision maker/Woman from SNE, 51 years old	“We organize all the mass events that the SNE carries out, we operate at a national level.”
	Clinic manager/Woman department head SALME	“SALME is a state reference, but it has also been a national reference in the entire care process it provides for the entire population without social security.”
	Provider/Female psychologist	“We do it multidisciplinarily, meaning I go out with the psychiatrist, the resident of the team, and social work.”
Interinstitutional collaboration and linkage	Decision maker/Man SM coordinator	“Another line I am managing from coordination is the ability to establish strategies and links with all the state universities so that students from medicine in undergraduate phases receive specific training to be able to collaborate when they enter professional activity.”
	Clinic manager/Man, director at SALME	“The reintegration program that was carried out in URI, in the comprehensive rehabilitation unit had, one, linkage with inclusive companies, two, with non-governmental organizations that allowed patients access to seek employment sources.”
	Provider/Female psychologist	“The rehabilitation unit did have this part of inclusive companies.”
Focus on the patient	System/Woman from SNE	“The job counseling is about what we are doing, about personalized attention, understanding the context in which the person is, if it’s a context of disability, understanding the limitations they present.”
	Provider/Male psychiatrist	“Provide job training to the patient linked with their family, and the family will receive a psychoeducational process from therapists that supports the environment for the patient’s rehabilitation.”
	User/Man diagnosed with SMI; 35 years old	“We are part of that, how they treat us, how they count us as equals. I guess we’re not so strange, just like normal people. I feel like being as normal as at my home, and it’s very different.”
Personal goals	Provider/Female nurse	“It’s very common for patients to express the desire to go out to work and in fact they tell you: I’m well now and I’m going to go out, I’m going to work to rent an apartment.”
	User/Woman diagnosed with SMI; 38 years old	“To be a better mother and to help me socialize more with my family, with my children and also to look for a better job.”
Viability of the IPS model	Decision maker/Woman from SNE, 38 years old	“I think it could have some applicability when the follow-up is focused and personalized.”
	Clinic manager/Man director SALME	“It’s good, because the idea is precisely that if the circumstances of each of the patients are personalized, obviously we are going to find specific support needs and even more so when a personalized follow-up is done.”
	Provider/Female social worker	“To give follow-up, especially that main thing.”
	User/Woman diagnosed with SMI; 38 years old	“It would help me to be able to work and to continue supporting and fulfilling my duties and concerns and somehow also continue organizing to have my health follow-up.”

¹In Mexico, a socially responsible company is one that, among other qualities, is supposed to maintain a commitment to recognizing people with disabilities in labor integration.