Cross-cultural studies of mental health and illness generally adhere to one of two agendas: the comparison of mental health between sites using standard measurement tools, or the identification of locally specific ways of discussing mental illness. Here, we illustrate a methodological approach to measuring mental health that unites these two agendas. Using examples from our work in India and Haiti, we show how researchers can use mixed methods to identify idioms of distress, develop locally derived tools to measure them, evaluate the psychometric properties of these tools, and contextualize the results with relevant ethnographic information. Such an approach is beneficial because it generates results that attend to important cross-cultural differences in expressions of distress while still maintaining comparability of mental health and illness across research sites.