Safeguarding adolescent mental health in India: a co-designed feasibility study of a systems intervention targeting youth anxiety and depression.

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Good mental health is essential to one's enjoyment of life, ability to have relationships and capacity for work. Mental health conditions like anxiety and depression are common, and evidence shows that these often start during the teenage years and continue into adulthood. India has the largest number of adolescents in the world (243 million) and many experience poor mental health. It is estimated that 9.8 million Indian 13-17 year olds have a diagnosable mental health condition, often anxiety and depression. There is widespread concern in India about the mental health of young people as suicide is the leading cause of death among adolescents. Young people in India who attend school are at even greater risk of poor mental health as Indian school culture places extreme pressure on young people and there widespread use of corporal punishment. Young people report that these have serious effects on their mental health. There is also little understanding of mental health in families or school communities and there is no school mental health programme in India, even though evidence shows that these can protect and improve mental health. There is an urgent need to find solutions to improve the mental health culture of Indian schools in order to safeguard the mental health of Indian young people. Our project, called SAMA (meaning equal in Sanskrit) aims to develop and test school-based interventions to provide Indian adolescents with information and strategies to take care of their mental health and to improve school cultures to support well-being. We know that interventions are most effective when they are designed by the people who will be involved or affected by them. Therefore, in Year 1 of SAMA, we will co-design interventions with young people, parents, teachers, school leaders, mental health professional, policy makers and representatives from Indian health and education departments. We will build on international evidence and interventions where available. We plan to have four interventions that (1) help young people understand and manage their own mental health, especially anxiety and depression; (2) help teachers reduce their use of corporal punishment and improve their understanding of adolescent mental health; (3) improve the school climate for mental health and reduce mental health stigma; and (4) improve parents' understanding of adolescent mental health to support their young person. We will develop plans to implement and evaluate these interventions, with close attention to training people who deliver them and how to prepare an intervention's 'soft landing' in school to increase chances of success. In Year 2, we will recruit eight secondary schools in Bangalore. We will test how feasible and acceptable the interventions are when delivered together in these schools and identify the cost implications. In Year 3, we will work with the communities to learn about what we need to do to improve interventions so that we can build towards a trial to determine if the interventions are effective. SAMA will also learn how to increase the use of evidence on school mental health programmes in Indian health policy. Throughout SAMA, listening to young people will be central. As well as being involved in the design and evaluation of interventions, other young people will be on our Youth Advisory Panel and still others will be involved in community filmmaking. Films will give outsiders an insider view into adolescent mental health and school in India. They will be used, along social media and community events, to raise awareness and campaign for better mental health care within Indian schools. Our UK-India partnership includes the National Institute of Mental Health and Neuroscience (Bangalore), Sangath (NGO in Goa), Mahatma Gandhi Institute (Puducherry) and the Universities of Leeds, Bradford, Birmingham and Oxford. SAMA will strengthen research capacity for school mental health research in low-and-middle income countries.