A Multilevel Governance Framework for Community-Based Mental Health Promotion: Findings from a Qualitative Study

Abstract

Mental health interventions in rural areas often face systemic and governance barriers that limit their implementation. This study analysed how governance dimensions at the municipal, state, and federal levels influence the perceived feasibility of implementing the Primary Care and Psychiatry Model (MAP-PSI), an early intervention strategy targeting adolescent depression in rural Mexico. A descriptive–interpretative qualitative design was employed, using semi-structured interviews and hybrid (deductive–inductive) content analysis. Participants were purposively selected institutional stakeholders involved in MAP-PSI implementation, including local health managers, state and federal decision-makers, and community-based actors. The coding process was collaboratively developed and validated through consensus and critical reflection among researchers. Five interrelated governance dimensions were identified: local leadership, intersectoral coordination, resource mobilisation, community participation, and institutional adaptability. These dimensions converge in a multilevel governance framework that illustrates how governance capacities across levels can enable or constrain community-based mental health interventions. The findings provide an empirically grounded framework to inform the design, adaptation, and future evaluation of community-based mental health strategies in underserved rural contexts.