The Big Picture:Adapting PhotoVoice to enhance psychological, social & cultural insights into & prevention & treatment of youth substance use in India

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This project focuses on understanding the lived experience of young Indian people around risk, recovery and resilience in relation to substance use disorder (SUD). The goal is to increase knowledge, enhance the voice of young people, and inform practice through impacting policy and promoting public awareness. Our visual participatory method - PhotoVoice (PV) - centralises the lived experience of young people in efforts to understand, prevent and intervene - at both a service and policy level - in substance-use-related mental health difficulties in India. The research will be conducted in Assam and we will explore transferability to other Indian States.Global mental health strategies prioritise adolescents given their potential trajectory towards lifelong disadvantage. Poor mental health in young people is also a risk factor for SUD, and the Childline Foundation reports that 13% of people using substances in India are children. In the National Mental Health Survey of India 2015-16, Assam has the lowest prevalence of mental disorders so offering an opportunity to understand psychological, social and cultural resilience. Even so, in Assam stigma around mental health problems is high, the treatment gap immense, and The Assam Report of The India Survey classifies adolescent SUD as an urgent problem. Our aims are to:-enhance psychological, social and cultural insights into the experience of risk, resilience and recovery with regard to youth substance use in Assam-promote young Assamese people's voice with respect to substance use in order to reduce stigma, raise public awareness and inform mental- and public-health policy and practice-learn if and how PV can be adapted in culturally-sensitive ways to enhance local mental health services seeking to prevent and treat youth substance use in Assam.We will conduct photo-led interviews with: (i) ~fifteen 15-18 year olds successfully refraining from substance use despite being at increased risk; and (ii) ~fifteen 19-24 year olds in successful recovery from SUD. These will be analysed using Thematic Analysis to explore protective and enabling factors around risk and recovery and will shed light on complex psychological, familial, social and cultural pathways to, and away from, SUD. Our innovation of PV is to extend it to participatory film-making. Hence, participants will be invited to make a poster of their photos to inspire ~6 short, resilience-focused films on the issues at stake and the changes they feel could best address them. We will also explore how evidence informs mental health policy and practice in Assam. We will review key policy documents and conduct ~15 interviews with purposefully-sampled stakeholders. Material will be analysed using Framework Analysis. We will hold 3 stakeholder workshops to credibility check our assessment of conceptualisations, practices and research-policy pathways, and to help plan public awareness and policy-directed activities.In relation to potential applications and benefits we will:-launch a social media mental health photographic campaign to raise awareness and understanding of how young people manage risks around substance use in order to stay well;-strengthen research capacity through training staff in our Partner Organisations in the design, delivery and analysis of PV and support them drive implementation where it will improve services;-promote PV as a low-cost, easy-to-implement tool initially targeting prevention and treatment of SUD;-develop an ESRC-compliant, open-access, educational, and resource e-mental health website including easy-to-use, culturally sensitive guidance on how to deliver, analyse and evaluate PV mental health projects, through to flexible ways that outputs can inform service development;-engage with key decision-makers pan-India who are able to facilitate wider service and/or policy level implications of outputs and contribute to the development of an Assam State mental health policy.