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

该项目的重点是了解印度年轻人在与物质使用障碍（SUD）相关的风险、恢复和复原力方面的生活经验。目标是通过影响政策和提高公众意识，增加知识，增强年轻人的声音，并为实践提供信息。我们的视觉参与方法——PhotoVoice （PV）——集中了年轻人的生活经验，努力在服务和政策层面上理解、预防和干预印度与药物使用相关的心理健康问题。这项研究将在阿萨姆邦进行，我们将探索可转移到印度其他邦的可能性。全球精神卫生战略优先考虑青少年，因为他们可能走向终身不利。年轻人的心理健康状况不佳也是SUD的一个风险因素，儿童热线基金会报告称，印度13%的吸毒者是儿童。在2015-16年印度全国心理健康调查中，阿萨姆邦的精神障碍患病率最低，因此为了解心理、社会和文化弹性提供了机会。即便如此，在阿萨姆邦，人们对心理健康问题的耻辱感很高，治疗差距巨大，《阿萨姆邦印度调查报告》将青少年SUD列为一个紧迫的问题。我们的目标是：-加强对阿萨姆邦青少年药物使用的风险，复原力和恢复经验的心理，社会和文化见解-促进阿萨姆邦年轻人对药物使用的声音，以减少耻辱；提高公众意识，为精神卫生和公共卫生政策和实践提供信息——了解是否以及如何以对文化敏感的方式调整PV，以加强寻求预防和治疗阿萨姆邦青少年药物使用的当地精神卫生服务。我们将对以下人员进行以照片为主导的访谈：(i)约15名15-18岁的青少年，尽管风险增加，但他们成功地避免了物质使用；(2) 15例19 ~ 24岁患者成功康复。将使用主题分析对这些进行分析，以探索风险和恢复周围的保护和促进因素，并将阐明影响SUD的复杂心理、家庭、社会和文化途径。我们对PV的创新是将其扩展到参与式电影制作。因此，参与者将被邀请将他们的照片制作成海报，以激发~6部短片，聚焦于面临的问题以及他们认为最能解决这些问题的变化。我们还将探讨证据如何为阿萨姆邦的精神卫生政策和实践提供信息。我们将审查关键的政策文件，并与有目的地抽样的利益相关者进行约15次访谈。材料将使用框架分析进行分析。我们将举办3次利益相关者研讨会，以核实我们对概念、实践和研究政策途径的评估的可信度，并帮助规划公众意识和政策导向的活动。关于潜在的应用和益处，我们将：-发起社交媒体心理健康摄影活动，以提高对年轻人如何管理药物使用风险以保持健康的认识和理解；-通过培训合作伙伴机构的员工，加强他们在光伏设计、交付和分析方面的研究能力，并支持他们推动实施，从而改善服务；-推广光伏作为一种低成本、易于实施的工具，初步针对SUD的预防和治疗；-开发一个符合esrc标准、开放获取、教育和资源的电子心理健康网站，包括关于如何提供、分析和评估PV心理健康项目的易于使用和对文化敏感的指导，以及通过产出为服务开发提供信息的灵活方式；-与全印度的关键决策者接触，他们能够促进产出在服务和/或政策层面产生更广泛的影响，并有助于制定阿萨姆邦心理健康政策。

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.