Involving young people with lived experience in advancing mental health science: an exploratory qualitative study from Pakistan and India.

Background: Meaningful involvement of young People with Lived Experience (PWLE) in co-designing youth mental health interventions has been much emphasized globally. However, there is a scarcity of evidence on involving PWLE of mental health problems in designing, implementing and evaluating mental health interventions, especially in Low- and Middle-Income Countries (LMICs). The aim of the current study was to understand the perspectives of young PWLE from two South Asian countries, Pakistan and India, regarding "Active Ingredients" (AIs) for youth mental health (i.e., components or processes of mental health intervention(s) that make a difference to mental health outcomes), as part of the Wellcome Trust AI Commission.

Methods: For this exploratory qualitative study, we conducted 30 qualitative interviews via Zoom with young PWLE from Pakistan (n = 19, 14 females and 5 males) and India (n = 11, 8 females and 3 males) to explore their views about different AIs for youth anxiety and depression in South Asia. The qualitative data was analysed using a thematic analysis approach that moved through the phases of familiarization, generation of codes, searching, identification and review of themes and selection of illustrative quotes.

Results: The results show that family and religion are integral to promoting positive youth mental health in the South Asian context. The AIs perceived to be most relevant for Pakistani and Indian young people were (i) improving social relationships; (ii) managing emotions; and (iii) relaxation techniques. Participants highlighted the need to explore the role of family support, personal space, spirituality/religion, schools, mental health literacy and stigma as potential AIs of mental health for young people in South Asia. The need for ease of access to mental health support and minimizing barriers to engagement with mental health services were highlighted as important contextual factors. Our findings highlight the need for culturally responsive youth mental health strategies that incorporate their preferred intervention components and address key challenges including stigma faced by South Asian youth.

Conclusions: The current study highlights specific intervention components and contextual considerations that are important to Indian and Pakistani young PWLE when designing and delivering mental health interventions. Our findings underscore the need to work with young PWLE and consider their context, culture, and resources when developing or evaluating mental health interventions. Given our sample likely represents a relatively advantaged group, future studies can use targeted sampling strategies to capture perspectives of young people from lower socio-economic strata.