Table 1.

Overview of the three research sites and country context

Research sites
Secretary of Health of the State of Hidalgo, Mexico	A decentralized health network that provides services to the ‘open’ population of the state. This state, divided into 13 health jurisdictions and 84 municipalities, has a population of 2 396 201 inhabitants, and 53.1% of them living in rural areasa. More than 320 029 speak a native language. In 2002, the psychiatric hospital was replaced by community services ‘Villa Ocaranza’. There are 467 primary health‐care centres, 13 hospitals and specialized care units, including services for addiction (e.g. UNEMEs) and mental health (Villa Ocaranza). Advances primary mental health is provided at 84 Núcleos Básicos en Salud Mental (within primary care centres) and 3 Módulos de Salud Mental b
Leon Local Integrated Health System (SILAIS), León, Nicaragua.	One of the 17 SILAIS in Nicaragua, situated in the north‐west of the country. It is part of the Ministry of Health and works in coordination with the National Health Program (2010) which gives a strong role to primary health care. It serves the Leon Department that has a population of about 441 308 inhabitants, including indigenous groups (e.g. Subtiaba) in 138.03 km², with rural and urban areas distributed in 10 municipalities. Services are provided with a strong emphasis on primary care. There are 10 centres and other smaller units for PHC; one Centro de Atención Psicosocial (CAPS) – Centre for Psyco‐Social Care – that provides ambulatory mental health care with a community approach; and one general hospital and no mental health hospitalsc
South East Metropolitan Health District, Santiago, Chile	One of biggest of the 29 health districts in Chile. It provides public services in the context of 3 subnetworks and 7 municipalities in the south‐east area of the Chilean capital under the umbrella of the Ministry of Health. There are 1 500 651 inhabitants (22.6% of the metropolitan population) in the assigned territory and around 76.5% of them have public insuranced. Mental health services follow a community network‐based approach.e There are about 40 primary care centres (e.g. CESFAMs), 7 specialized community mental health facilities (COSAMs), 3 specialized mental health outpatient facilities (CRS and CDT), one mental health hospital (El Peral) and mental health beds within the general hospitalf

Countriesg
Socio‐demographics and health indicators	Mexico	Nicaragua	Chile
Population in 2010 (millions)	112.3	5.9	17.1
Poverty rate % (year)	47.4 (2008)	44.7(2009)	15.1 (2009)
GINI coefficient	48.3 (2008)h	40.5 (2005)i	52.1 (2009)n
Literacy rate (%) (2010)	93.1	96.6	98.6
Political organization of the territory	The Federal District plus 31 states, 2638 municipalities	15 departments, 2 autonomous regions, 153 municipalities	15 regions, 53 provinces, 346 communes
Life expectancy at birth (years) (2010)	76.7	74.5	79.0
Infant mortality rate (per 1000 live births)	14.9 (2009)	29.0 (2006)	7.9 (2008)
Budget for health as a % of the GDP	6.9 (2009)	5.41j (2009)	8.3 (2009)
Budget for mental health (% of health budget)	2k (80% of it for psychiatric hospitals)	1 l (91% of it for psychiatric hospitals)	2.14m (33% of it for psychiatric hospitals)
Provision of health services	Segmented health system with four components: public institutions for uninsured population (e.g. Servicios Estatales de Salud – SESA), IMSS‐Oportunidades, social security institutions (IMSS, ISSSTE, Seguro Popular de Salud – SPS) and the private sector.n	Mainly public. The public sector is made up of the Ministry of Health (65% of coverage), the medical services of the Army of Nicaragua and the National Police Force, and the Nicaraguan Social Security Institute (INSS). The country offers a national health policy that promotes a multisectoral approach to dealing with health issues. In 2007, the country started the implementation of the family and community health model (MOSAFC)o	Segmented health system with a public component that serves around 75% of the population and a private one.p PHC works with a family and community health approach and is managed by municipalities in coordination with health districts. Beginning in 2000, a health reform was implemented. It includes the AUGE Plan, a regime of explicit guarantees (access to treatment, opportunity, quality and financial protection) for prioritized conditions, including some mental health issues

^aSee Ref. 44.

^bBased on the information collected during the site visit on December 2010.

^cBased on the information collected during the site visit on February 2011.

^dSee Ref. 45.

^eSee Ref. 46.

^fSee Ref. 47.

^gMain source of information: PAHO (2012) Otherwise, additional sources are indicated (see Ref. 48).

^hSee Ref. 49.

ⁱWorld Bank.

^jSee Ref. 50.

^kSee Ref. 51.

^lSee Ref. 52.

^mSee Ref. 53.

ⁿSee Ref. 54.

^oSee Ref. 55.

^pSee Ref. 56.