title: Barriers to Integrating Mental Health Services in Community-Based Primary Care Settings in Mexico City: A Qualitative Analysis.
abstract: OBJECTIVE
  Despite the high prevalence of mental disorders in Mexico, minimal mental health services are available and there are large gaps in mental health treatment. Community-based primary care settings are often the first contact between patients and the health system and thus could serve as important settings for assessing and treating mental disorders. However, no formal assessment has been undertaken regarding the feasibility of implementing these services in Mexico. Before tools are developed to undertake such an assessment, a more nuanced understanding of the microprocesses affecting mental health service delivery must be acquired.
  
  
  METHODS
  A qualitative study used semistructured interviews to gather information from 25 staff in 19 community-based primary care clinics in Mexico City. Semistructured interviews were analyzed by using the meaning categorization method. In a second phase of coding, emerging themes were compared with an established typology of barriers to health care access.
  
  
  RESULTS
  Primary care staff reported a number of significant barriers to implementing mental health services in primary care clinics, an already fragile and underfunded system. Barriers included the following broad thematic categories: service issues, language and cultural issues, care recipient characteristics, and issues with lack of knowledge.
  
  
  CONCLUSIONS
  Results indicate that the implementation of mental health services in primary care clinics in Mexico will be difficult. However, the information in this study can help inform the integration of mental health into community-based primary care in Mexico through the development of adequate evaluative tools to assess the feasibility and progress of integrating these services.
authors.affiliation: Dr. Martinez is with the School of Public Health, University of California, Berkeley (e-mail: wmartinez@berkeley.edu ). The other authors are with the Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City.
authors.forename: William
authors.initials: W
authors.lastname: Martinez
authors.affiliation: Dr. Martinez is with the School of Public Health, University of California, Berkeley (e-mail: wmartinez@berkeley.edu ). The other authors are with the Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City.
authors.forename: Jorge
authors.initials: J
authors.lastname: Galván
authors.affiliation: Dr. Martinez is with the School of Public Health, University of California, Berkeley (e-mail: wmartinez@berkeley.edu ). The other authors are with the Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City.
authors.forename: Nayelhi
authors.initials: N
authors.lastname: Saavedra
authors.affiliation: Dr. Martinez is with the School of Public Health, University of California, Berkeley (e-mail: wmartinez@berkeley.edu ). The other authors are with the Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City.
authors.forename: Shoshana
authors.initials: S
authors.lastname: Berenzon
mesh_terms: D001291:Attitude of Health Personnel; D003153:Community Health Services / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D008605:Mental Health Services / Q000458:organization & administration* / Q000592:standards; D008800:Mexico; D011320:Primary Health Care / Q000458:organization & administration* / Q000592:standards; D036301:Qualitative Research
keywords: Community mental health centers; Community mental health services; Primary care; Public policy issues; Public-sector psychiatry