The growth of identity struggles and intersectional debates has presented challenges for public health services in Chile and Brazil. In this context, researchers, stakeholders, health practitioners, and activists have recently brought contemporary debates on professionals’ competency to the fore. Debate in Chile and Brazil has primarily centered on US-based discussions on cultural and structural competency. However, emerging concerns regarding identity, intersectionality, and mental health among vulnerable or marginalized groups have confronted local health traditions with the need for specific interpretations of concepts such as ‘culture’ and ‘structure’. In this commentary, we delve into the recent history of psychiatry and public health in Chile and Brazil to reveal how ideologies and politics have influenced local traditions in mental health practice and their interaction with ongoing identity struggles and intersectional debates. We argue that recent historical and sociopolitical factors in both countries have shaped a structural-based approach to mental health practice. The introduction of gender and multicultural policies in public health has contributed to a more complex understanding of Otherness and power relationships in recent decades. Although this understanding largely aligns with those prevalent in the USA and UK, there is a strong emphasis on class in identity struggles and intersectional debates in public health, providing a distinctiveness to Latin American debate. Understanding professional competencies requires consideration of broader sociopolitical processes. Rather than a de-contextualized understanding of ‘culture’ and ‘structure’, the history of psychiatry demonstrates how these categories interact within specific political and ideological contexts.