Rethinking the role of participatory video for school mental health interventions: insights from a feasibility study in Indian secondary schools

Rethinking the role of participatory video for school mental health interventions: insights from a feasibility study in Indian secondary schools | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Rethinking the role of participatory video for school mental health interventions: insights from a feasibility study in Indian secondary schools Ritwika Nag, Sphoorthi Prabhu, N Janardhan, Kier Harris, Paul Cooke, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9384591/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Background : Although Participatory Video (PV) is heralded as a powerful form of public participation in research, evidence about its ability to support equitable and inclusive research in low-and-middle income countries is lacking. Our study investigated the feasibility of PV as a tool to support evaluation of a community co-designed, whole school mental health program (Project SAMA) in Karnataka, India. Cultural perspectives around youth voice and stigma related to mental health in India presented uncertainties about the acceptability of PV in this context. Our aim was to determine if PV was a feasible and helpful methodology for school mental health research in India and whether it benefits young people directly. Methods: Thresholds for feasiblity and helpfulness were established. Following a train-the-trainer model, we delivered filmmaking workshops to adolescents in school (n=56, 12-16y) and they were invited to make films about their wellbeing in school and their experience of the SAMA program. Four films were created and screened in the filmmakers’ schools, at a stakeholder event and on the project's YouTube channel. Films were analysed via thematic analysis. Data was collected via audience feedback (n=56), focus group discussions with the filmmakers (n=31) and critical research team reflections. Results: Four films were created and screened to n=286. Feasibility and helpfulness thresholds were met. Film analysis revealed participant perspectives on school wellbeing and the SAMA program not revealed in other forms of project evaluation. PV was found to benefit young people directly spanning skills development, confidence building and greater self-awareness. PV appeared to support school engagement and ownership of the program. However, power hierarchies and understanding of the political or advocacy potential of PV remain critical issues. Conclusions: Our student demonstrates the feasibility of PV to advance youth perspectives on adolescent and school mental health research in India. Our study showed that PV can support psychological ownership of interventions and could be considered as an intervention mechanism. PV for public mental health research should remain critically self-reflective and focus on generating evidence-based practice. Adolescent Public Mental Health School India Participatory Video Interventions Figures Figure 1 Plain English Summary Participatory Video (PV) is a method where people create short films to share their own experiences, rather than being studied only through surveys or interviews. While PV is often promoted as a way to give communities a stronger voice, there is limited evidence about how well it works in low‑ and middle‑income countries, particularly with young people and sensitive issues such as mental health. This study explored whether PV could be used in Indian schools to help evaluate Project SAMA , a school mental health programme co‑designed with communities in Karnataka, India. In this context, young people are not always encouraged to speak openly, and mental health remains stigmatised. As a result, it was uncertain whether making and sharing films would be acceptable, useful, or safe. Using a train‑the‑trainer approach, researchers supported 56 students aged 12–16 to learn basic filmmaking skills and create films about their school wellbeing and experiences of the SAMA programme. Four films were produced and screened in schools, at a public event, and online. Data came from audience feedback, group discussions with student filmmakers, and reflections from the research team. The study found that PV was both feasible and helpful. The films revealed insights into students’ school lives and mental health that were not captured by other evaluation methods. Participation also benefited students by building skills, confidence, self‑expression, and reflection, and increased their sense of engagement with the programme. Challenges remained, particularly around adult–youth power dynamics and limited understanding of the films’ wider advocacy potential. Overall, the study shows that PV can be a valuable and engaging tool for school mental health research in India when used carefully and critically. 1 Background This paper contributes to ongoing advocacy for more participatory practices in global mental health research for young people. Although not new, participatory methods continue to be encouraged in both high-(HICs) and low-and middle-income countries (LMICs) due to frustrations about the relatively low impact of some social science research and the unacceptable exclusion of community (compared to scientific) knowledge about the community’s own lives [1]. This is particularly important for groups historically marginalised from research about them and for them, including young people [2]. There are thus ongoing calls for changes to the way research and knowledge generation is conceptualised and executed [3]. Participatory research aims to secure voice, representation and community-led change and its ostensible benefits have been widely reported, from empowerment to a sense of belonging, to improved mental health [4, 5, 2, 6, 7]. Participatory research is also typically valued for its ability to break down power hierarchies and, in relation to youth mental health research, to highlight the ways in which adolescents can present authoritative knowledge of their own lives and experiences [8]. This is critical given the failings of adultism and adult-led models of practice [8]. Our focus is on participatory filmmaking (generally termed in the literature ‘participatory video’, PV), where a community creates a film to both reflect on and catalyse social transformation on an issue of importance to them [9]. Often viewed as grassroots, democratic and decolonising method, many studies report PV as highly successful [10, 11, 12, 13]. However, there are criticisms about the “mythologising of the power of participatory methodologies to accomplish problem solving, emancipation or empowerment” [14]. This criticism extends to PV, where the relative lack of critical evaluation of project outcomes raises questions about what the specific value of this form of participatory research may or may not be. A more robust evidence base is required if the field is to learn and improve [15]. In this paper, we offer a critical examination of PV as a participatory method with young people in mental health research, drawing from our use of PV in a co-design and feasibility study of a whole school mental health program in Bangalore, India. Adolescent Mental Health in India Poor mental health accounts for 45% of the global burden of disease in 10–24-year-olds and most of this fall on young people in LMICs [16]. India is home to the largest number of adolescents worldwide [17]. Nearly 24% of Indian school-going adolescents have a mental health condition [18] and suicide is a leading cause of adolescent death [19, 20]. Despite having the greatest level of need, mental health support for adolescents globally and in India has been woefully invisible and its shoehorning into adult medico-psychiatric models of practice is frequently failing young people [21, 22]. The extent of unmet need requires radical new ways of thinking about and responding to youth mental health. McGorry et al. (2022) argue that this requires shifting our research focus to community engagement, education and consultation; youth participation, respect and co-design; prevention and early intervention; and the use of evidence-based approaches. This shift is beginning to gain traction in India but is at an early stage [23], where participatory mental health research with adolescents is rare, but growing [24, 25]. Calls for ‘youth voice’ in research must retain vigor and urgency given the scale of the problem [2]. Our paper supports this growth through the presentation of our evidence on the potential of PV as a participatory tool to increase the effectiveness of adolescent mental health interventions in India. Participatory Research: The Potential of Participatory Video Community-led filmmaking as a tool for community reflection and advocacy is generally seen as a valuable participatory methodology. The global literature indicates that PV can bring new knowledge and empathy towards an issue, often challenging assumptions and stereotypes that may be hindering progress [26, 27, 28, 7]. As audio-visual media such as film are often more accessible and impactful than written texts [29], PV is frequently seen as holding powerful communicative potential to emotively influence decision-makers at local, national and global levels in ways that other community-engagement methods might not. Moreover, participants who make films often also begin to see themselves as ‘agents of change’ [30]. This is rarely an outcome of traditional research methods that can often appear extractive to participating communities [31]. PV films can also help to raise awareness of a project, engaging stakeholders and disseminating findings more effectively than projects without ready access to shareable audiovisual material [32]. Project Sama: The Critical Challenge of PV In India, a small number of PV projects have been conducted with children and adolescents including children with disabilities [33], street children [34], and youth at risk of substance-use disorders [32]. There are no published studies on the use of PV in adolescent mental health research in India. We opted to use PV in our study, Project SAMA (Safeguarding Adolescent Mental Health in India), a Community-Based Participatory Research (CBPR) [35] study to co-design and feasibility test a whole school mental health intervention for adolescent wellbeing in Bangalore. We hoped to engage adolescents in PV as a platform for them to articulate what matters in terms of their wellbeing in school and their experience of our co-designed whole school intervention. We hoped that the created films would first be powerful and direct youth communication to decision-makers regarding mental health in Indian secondary schools and second, would provide additional research insights to supplement our standard intervention effectiveness data [25]. However, whether PV would be a feasible methodology in our context was unclear. While the tone of the literature on PV is overwhelmingly positive, PV does not always succeed. [36], for example, report on a failed attempt to use PV with a LGBTQIA+ community experiencing homelessness in New Zealand which reinforced rather than subverted power dynamics. One participant stated: “it doesn't feel like participatory or like a partnership at all. It feels like academics have chosen and stuck with a method that the community doesn’t want” (p6). A further barrier in Fraser et al.’s study was that participants, who already felt stigmatised and vulnerable, sought invisibility not visibility via filming. This was pertinent to our project given the high stigma attached to mental health in India, and the vulnerability young people may feel in speaking ‘visibly’ [37]. A second uncertainty for us in using PV was that it could be perceived as a colonial practice encouraging western values around adolescent voice and agency that are inappropriate in the Indian school system [38]. Risks are often intensified when PV projects are co-led across countries; in our case, the UK (a former colonial power) documenting youth mental health in India might be seen as a colonial gesture rather than one that served a true local appetite for participatory research [39]. Given the scarcity of youth participatory research in India, there were also risks that PV might be considered solely as a youth-development activity. Finally, when young people are invited to make films about their mental health, there is a risk of exposing systemic problems that are uncomfortable for stakeholders, creating tensions around reputational damage and who is held to account (as was experienced in [36]). PV cannot in and of itself escape established power dynamics and may even play out the very power dynamics the method ostensibly seeks to challenge [40]. Aims To understand the potential and challenges of using PV in Indian school mental health research, (Project SAMA), we examined two interrelated questions: Is PV a feasible and helpful methodology for school mental health research in India? For PV to be considered feasible, we set a target (as is routine in feasibility studies, [41]) that we should be able to: train a core group of Indian researchers in PV to the level of being able to produce a basic film and train others to do the same; engage and get consent for at least two of the SAMA study schools and ten young people to make a minimum of two films; and secure permission to screen the films in those schools. For PV to be considered helpful for intervention research, we wanted PV to generate new youth-centered insights on adolescent mental health in India and on our intervention. Does PV benefit young people directly? The WHO’s Global Consensus Statement defines meaningful youth participation in research as “an inclusive, intentional, mutually respectful partnership between adolescents, youth, and adults whereby power is shared, respective contributions are valued, and young people’s ideas, perspectives, skills, and strengths are integrated into [outcomes]” [42]. We examined whether our use of PV could meet this standard. 2 Methods PV was a workstream of Project SAMA which was a 3-year research collaboration between the National Institute of Mental Health and Neurosciences (NIMHANS), the Universities of Leeds, Birmingham, Oxford and the London School of Hygiene and Tropical Medicine in the United Kingdom (UK). It was funded by the UK’s Medical Research Council, National Institute of Health Research, UK Aid and the Economic and Social Research Council. Whilst there are many school programs in India to support youth in life skills [43], there was no whole school program in India which worked across actors and systems to promote protective factors (e.g. positive relationships) and reduce risk factors (e.g. punitive teacher practices). The project’s main aim was to co-design and feasibility test a whole school program to support adolescent wellbeing in secondary schools, with the primary aim of reducing symptoms of anxiety and depression. Following a systematic review of global literature to identify candidate whole school programs, or components of them [44], we conducted 15 co-design workshops with adolescents, educators, parents and mental health professionals in the state of Karnataka (in the regions of Bengaluru, Bangarpet and Kolar). The final designed intervention had components targeting adolescent mental health literacy and capacity for self-care, teacher mental health literacy and capacity for positive discipline practices, school climate (including reduction of bullying) and parent mental health literacy. Lay counsellors (called SAMA Sneitharus - the Kannada word for friends) were recruited, trained and embedded in schools for between 6-8 months to deliver the intervention and provide support to students and staff in implementing SAMA. Our primary purpose was to examine intervention feasibility, and we tested this in five intervention schools and three waitlist schools [25]. Our plan was to use PV in the study schools to create adolescent-led films that highlighted participants’ everyday experience of school, how it influenced their mental health and their experience of the SAMA intervention. The SAMA team included a highly experienced participatory filmmaker (PC) who has worked with adolescents globally on challenging issues, from the experience of undocumented children in South Africa to the impact of substance use on young people in India [45, 32]. PV Method Our approach to PV was grounded in a method summarized in Shaw and Robertson [46, 47, 48] who provide four widely accepted ground rules for PV projects. These are that: all participants take turns in a variety of production roles and roles are rotated regularly; all participants who want to can perform in front of the camera each session; all video material is played back to participants after each session; and video recordings are confidential and only shown externally if all participants agree [47]. Step 1: Train the trainer model We adopted a train-the-trainer model, cascading knowledge and capacity for PV across the SAMA Indian research team (based in NIMHANS), then to lay counsellors based in study schools and then to early career researchers (ECRs). As per global agendas for capacity building [49], our train-the-trainer model aligned with a project commitment to build in-country capacity for new research methodologies. Work began with a series of train-the-trainer online workshops facilitated by PC for a core team of SAMA project staff in NIMHANS on the basics of film production (e.g. using the camera, framing shots, sound recording, telling a compelling story, and basic editing skills). Following training, the SAMA team developed a manual to guide their approach to working with adolescents (Training Young People in Filmmaking). This included plans for six workshops that take participants through the steps of developing, producing and screening a film in, and with, their community. The manual built on one produced in an earlier project led by PC (Community Arts for Antibiotic Resistance across Nepal), which used PV to support communities in finding appropriate solutions to the misuse of antibiotics [32]. Step 2: Recruiting PV Participants We recruited adolescents from schools participating in the SAMA intervention study via announcements made by lay counsellors. Adolescents were informed that taking part would: (i) require parental permission and personal consent, following reading of the full study information letter; (ii) involve attending film workshops on school premises with other young people, researchers and filmmakers to create short films to help viewers understand what affects adolescent well-being in school; and (iii) that they could decide if they wanted to use their own name and/or appear on camera. Step 3: Creating films Film workshops took place on school premises supported by an Indian SAMA researcher (trained in PV) and the lay counsellor embedded in the schools. The film workshops were conducted over 1-2 days in the schools following the steps outlined in Table 1. Table 1: Steps in filmmaking in schools 1 and 2 Step Tasks Learning the basics of film production Participants were taught to use the camera, frame shots, record sound, how to tell a compelling story, different modes of telling a story (documentary versus fiction filmmaking; animation versus live action) and basic editing skills. A ‘learning by doing’ approach was adopted: participants would try an activity and discuss what went well and what could be improved. Collaborative script development Facilitators made clear that the film should relate to their wellbeing in school and /or their experience of SAMA, but that they could choose their focus. Once chosen, work began on idea generation, thinking about the potential audience for the films and how they could tailor their story to reach this audience. This was followed by consensus-building exercises, storyboarding and possible scenes to shoot. Implementation of the script Input from each participant was sought to finalise the ‘shooting script’. Participants selected locations. Trainers helped to ensure that the group remained silent when filming and facilitated the engagement of teachers and other staff as interviewees in some of the films. Editing and reflective analysis of the films After an hour of filming, each group watched what they had recorded on a wall in the classroom. Adolescents were asked to reflect on the content and shooting and what they would like to see in the final film and what kind of emotional ‘feel’ they wished to present. In school 1 there was limited availability of software on site for editing. Therefore, this was primarily undertaken by SAMA staff, in accordance with the adolescent-generated storyboards and shooting scripts. Participants were consulted on a rough cut and the final edit. In School 2 students edited the films on their own, with the rest of the group collaborating in discussion of the edit, as well as the use of music and the overall design of the film. Step 4: Film Screenings Each participating school screened their films with the permission of the filmmakers and the support of the SAMA team, who facilitated discussion post-screening. Films were also uploaded to our project YouTube channel and shown at a project impact event. Data collection and analysis We addressed our research questions by drawing on different data types as summarised in Table 2. Table2: Data used to address our research questions Research Question Data PV completion rates Film analysis Impact event stakeholder responses Focus groups (n= 31) Research team reflective practice 1. Is PV a feasible and helpful methodology for school mental health research in India? ü ü ü ü ü 2. Does PV benefit young people directly, supporting equitable research? ü ü ü To examine research question one, we assessed outcomes against our feasibility targets. To explore whether PV was a ‘helpful’ methodology, we drew upon film analysis, adolescent focus groups, impact stakeholder responses and our team reflective practice. Films were analysed using reflexive thematic analysis (RTA, Braun & Clarke, 2019). Step one of RTA involved multiple viewings of the films as a project team (n=9), spanning Indian and UK research expertise in psychology, clinical psychology, social psychiatry, film studies, PV and school mental health. We discussed scenes, characters and overarching narratives with a focus on what the films revealed about adolescent mental health and our school intervention. To attend to multiple dimensions of the films, we used a range of stimulus questions exploring: (i) the visual aspects of film (e.g. how the camera captured the environment); (ii) audio (e.g. what is the sound doing in the film: is it diegetic or non-diagetic and how does this change our understanding?), (iii) narrative (who or what is in the film, who is missing that we might expect, what are the possible latent and semantic meanings?); and (iv) editing (e.g. how is the story put together, what is the pace of the film and how do transitions shape the story?). We generated notes from Step 1 which helped orientation for Step 2 of RTA. This involved two researchers independently conducting line-by-line open coding of the films as audio-visual ‘texts’ (Point and Baruch, 2023), discussing and agreeing final codes and, in Step 3, generating initial themes. These were brought for review by the project team involved in Step 1. Our aim here was to refine and define themes (Steps 4-5). We also examined research question one at a SAMA Impact event in India (2024) where we invited attendees to anonymously complete a questionnaire (Appendix 2) which asked: According to you, was the film easy to understand?; Did the film help you understand more about SAMA?; What for you was the best part of the film?; What for you was the key message of the film?; What do you think could have been done differently in in the film? Responses were content analysed. To explore aspects of research questions one and two, we conducted focus groups with the adolescent filmmakers. School, parent and individual consent had been secured for this at the point of PV recruitment. Focus groups, reaching n= 31 adolescents were conducted separately on site in the government and private school immediately after the film screening in their schools. The discussion was scaffolded by a question guide (Appendix 1) designed to help adolescents share experiences, insights and challenges encountered during the PV process. Discussions were video recorded with consent, transcribed verbatim and subjected to a basic thematic analysis conducted independently by two SAMA research staff. Steps included data familiarisation, line-by-line coding, generating preliminary themes, and refining final themes. The coders agreed the final themes. 3 Results We present the results of our study under our two research questions. Question One: Is PV a feasible and helpful methodology for school mental health research in India? Feasibility was established via a train-the-trainer model (Fig. 1 ). We met our feasibility threshold of training a core group of Indian professionals (n = 17) in PV to the level of being able to produce a basic film and use the SAMA manual to train adolescents. Four study schools consented to take part, exceeding our target of two. We recruited and trained n = 56 young people, exceeding our target of 10. Of these, 25 were not available at the time of PV launch in their school (due to exams, school trips etc). For the film team, 20 were recruited from school 1 (rural government school, co-education, English medium of instruction) and 11 were from school 2 (urban private school, co-education, English medium of instruction). Ages ranged from 12–16 years (males) and 13–16 years (females). Both schools had completed the youth-focused, classroom component of the SAMA intervention but other intervention components (school climate, teacher and parent components) were ongoing when PV was initiated. Four films were produced, exceeding our target of two. We met our target of securing permission to screen the films in at least two study schools. School 1 screened the films in a special event attended by students, teachers and the headteacher (total n = 80). School 2 screened the film in a school assembly attended by students, teachers and the headteacher (total n = 150). Films were uploaded to our YouTube channel, accompanied by a question to help viewers reflect on the films and how they might relate to their own context. To date, films have attracted around 500 views. Film analysis That PV was a ‘helpful methodology’ (part of research question one) was established via six themes, generated from analysis of the four created films. Table 3 summarises the film content, linked to themes, which captured important insights about how the young people see mental health difficulties arising, their experiences of this and how they might try to find resolution of difficulties. Themes were: (1) Trouble and stress leads to poor mental health. Young people conveyed that feeling troubled and distressed as their phenomenology of mental health; ( 2) It’s about what’s happened to me. This conveyed that distress emerges from things that happen to young people and not from internal dysfunction or deficiency; (3) Just cope alone . Adolescents are likely to try to cope for a long time on their own without seeking help; (4) Nothing can be done. Films conveyed that adolescents often do not see anything obvious that they can do to overcome their difficulties; (5) When others notice . Other people noticing they are not okay is important; and (6) Relational safety and validation. Adolescents conveyed that they need a safe relational space, in which they are taken seriously, as a first step towards unlocking internal and external resources to cope. Validation comes with ‘help that helps’ and includes practical action. Films also revealed youth perspectives on the SAMA intervention which differed from those of the research team in four main ways (Table 3 ). These allow us to examine how PV might be a ‘helpful’ methodology to enable our intervention development and school intervention research more generally. First, the intervention was perceived differently by adolescents compared to teachers or the research team as intervention designers. Adolescents focused on the need for ‘something’ in school to help them feel taken care of emotionally, whereas SAMA designers and school staff conceived of the intervention as a way to advance students’ mental health literacy and potential for self-care. Second, for adolescents, the lay counsellor component was centre stage in its importance and helpfulness. Although this role was planned-by-design, we did not anticipate this component trumping all others (e.g., psychoeducation, positive classroom practices). Sharing problems with a lay counsellor was presented as providing the relational space for empathy followed by practical guidance, formulated as the ‘perfect mix’ by students. Third, the very simple Speak Out box was a more significant intervention component for adolescents than we anticipated; it provided easy, private access to a lay counsellor and removed the pressure from students to initiate contact via a face-to-face conversation. The films underscored for us the importance of enhancing this intervention element in future iterations. Finally, students perceived the intervention as giving them a platform for youth action, and the importance of this for peer-to-peer dialogue about things that are troubling them. Without the intervention, students did not see any other obvious form of, or route to encourage, youth-led action. We had envisaged the peer roles as an important way to liaise with the lay counsellor but did not anticipate they would feel empowered to take action themselves on issues such as bullying. Further insights into the helpfulness of PV for intervention research are reported under the focus groups analysis in the next section. Table 3 Details of the four films produced by adolescents and analysis of their representation of mental health and the SAMA whole school intervention. Title Duration and form Description What do the films tell us about adolescents’ views of mental health? What do the films tell us about adolescents’ view of SAMA? SAMA and Us 7min 56 sec Documentary Adolescents were invited to make a film reflecting on SAMA in their school. They began with what they valued about the program before interviewing their lay counsellor, a teacher and the head teacher. They highlighted aspects of SAMA they considered to be the most important. 1. Poor mental health arises for adolescents from having many life problems (compared to teachers who feel adolescence as a problematic age). (Themes 1 & 2) 2. Not being able to share problems (because of the lack of empathic adults) gives rise to mental health difficulties. (Theme 1) 1. Students have different views of the need for, and mechanisms of SAMA, compared to staff. 2. SAMA fills a need for adolescents to feel taken care of emotionally in school. (Theme 6) 2. The lay counsellor is the ‘centre stage’ element of SAMA for students. (Theme 6) 3. The Speak Out box removes the challenge of initiating a direct approach to a lay counsellor and is a critical mechanism to make help-seeking easier. Viona is back on track 3 min 34sec Animation Explores the stress felt by its protagonist, Viona, as she lives with serious difficulties at home. SAMA is presented as a useful programme to help her address this pressure, to overcome her mental health problems and to get “back on track” 1. Good adolescent mental health is indicated via relational, social and academic stability. 2. Adolescent mental health is affected first by external events which become internal events. (Theme 2) 3. Adolescents can pretend they are okay despite being ‘broken’ inside. (Theme 3) 4. Distress can take time to seep out and be visible to others in school. (Theme 5) 5. Adolescent distress needs a relational solution followed by a practical solution. (Theme 6) 6. There is often no obvious relationship for adolescents to experience help in school. (Theme 4) 7. A focus on ‘what is happening to you’ is important to adolescents (vs what is wrong with you). (Theme 2) 8. Via ‘helps that helps’, good mental health can be restored despite ongoing life circumstances. (Theme 6) 1. That SAMA was the only obvious form of help (to the story character). 2. There is tension between wanting and fearing help-seeking in SAMA due to potential stigma. 3. Having multiple ways to access help is important in school. 4. The Speak Out box was important for ease and privacy. 5. Lay counsellors are a relational space to provide empathy and guidance to handle emotions and situations. 6. Sharing problems with the lay counsellors stimulates recovery and problem resolution. Aryan Vs the Bullies: 3 min 45 sec Animation The impact of several months of bullying on quiet Aryan, who did not know how to handle this and whose academic life and wellbeing was deteriorating rapidly. How SAMA peer and lay counsellor components provided a route to empower Aryan to address the bullying. Without this, his mental health trajectory would be ‘ruined’ 1. Bullying is a known harm in schools that affects vulnerable students in extreme ways. (Theme 2) 2. Adolescent mental health is affected first by external events which become internal events. (Theme 2) 3. Adolescent distress needs a relational solution followed by a practical solution. (Theme 6) 4. There is often no obvious relationship for adolescents to experience help in school. (Theme 4) 5. A focus on ‘what is happening to you’ is important to adolescents (vs what is wrong with you). (Theme 2) 6. Bullying must be eradicated to protect adolescent mental health. (Theme 2) 7. Via ‘helps that helps’, good mental health can be restored and even enhanced. (Theme 6) 8. Restoration of mental health does not always need psychological input. (Theme 6) 1. Peer mediators can take action for vulnerable students who may not be able to do so themselves. 2. When given power to influence, adolescents will take immediate action against bullying of their peers. 3. Routes to engage with adults in school are crucial to trigger helps that helps. 4. Being taken seriously and being involved in decisions are critical steps towards being empowered to address bullying 5. SAMA provided routes to being taken seriously and routes to action. Handling stress 3 min 20 sec Live-action fictional film Close up of the adolescent experience. The adolescents show how the academic journey of a student is often accompanied by the significant, but frequently overlooked challenge, of stress. Stress may appear in the form of academic pressure, social pressures or extracurricular overload. The film suggests that the stress faced by adolescents in schools can have profound effects on their mental health, academic performance, and overall well-being and how it is important to give students the support to overcome these challenges. 1. Stress emerges from pressure placed on adolescents in schools. (Themes 1 and 2) 2. Not talking adolescent stress seriously is a risk for their mental health. (Theme 3) 3. Mental health is supported by responsive action. (Theme 6) 4. With encouragement, students want to play a central role in promoting mental health in schools themselves. 5. Having strategies to manage stress can help mental health. (Theme 1) 1. The lay counsellor is available, open, validating and invited ‘working together’ on managing stress. 2. SAMA (via the lay counsellor relationship) gives students a platform to drive forward their own action on adolescent mental health in school. 3. Students involved in leading school mental health activities experience personal benefits and a sense of pride. Question Two: Does PV benefit young people directly, in an inclusive and non-extractive way? That we recruited participants identifying as male (n = 18) and female (n = 13) suggests the methodology appeals to both adolescent boys and girls. Collaboration and inclusive participation from all involved were evident, although boys tended to be more interested in technical aspects (e.g. handling the camera, editing) and girls more interested in writing scripts, acting or narrating. Analysis of the focus group discussions helped us to understand adolescents’ experiences across four topic categories, summarised below with illustrative quotations tagged by school (S) and adolescent id (A). Category 1: Experience of filmmaking The relatively short, basic training in PV provided by the SAMA team, supported by lay counsellors, appeared fit-for-purpose, making them feel equipped to execute the filming relatively quickly. Adolescents described the training as “awesome” (S2, A3) and "very exciting” (S2, A2). Hands-on, interactive training was especially welcomed by the adolescents: “on the second day we had a recap of the parts of the camera and the tripod and stands. It was very helpful...it was very interactive, I loved it a lot” (S2, A7). Taking part in PV was reported to be an extremely positive experience in four main ways. First, the experience was described as novel and “cool”: “We got opportunities to act and do new things and discover stuff.” (S2, A7) and “it was the first time I ever held a camera in my hand so that was like really cool.” (S2, A9). Second, PV was consistently described as fun, often attributed to the fact that they were filming with peers (“It was fun shooting and acting with my friends” (S2, A8) and because they had freedom on the school site: “My favourite part honestly was running around the school…we all had a lot of fun!” (S2, A10). Fun was also reported because of a type of flow or absorption in the task: “I forgot everything else. It was a fun experience.” (S2, A10); “I had fun editing also and the experience was so good” (S2, A3). Third, several participants reported a positive experience because of new insights into themselves. For some, this was because they did things that they had not expected they could do (“the entire filming process helped us discover new things in ourselves” (S1, A10); “I had never expected that I would be on screen...that I would be able to contribute to mental health awareness” (A2, 029). A new awareness of personal competence was experienced by some: “I felt efficient” (S2, A1); “We came to know that we are good directors, and illustrators and can do so much more” (S1, A10). Fourth, PV was described as positive because it was experienced as a unifying experience among the adolescents: “I like the way we all came together. All of us did teamwork and I really appreciate it” (S2, A6). They also felt that SAMA had “given each one of us a chance to voice out our opinions” (A6,029). One participant reported a profound impact: “This filming workshop by SAMA helped me recognise who I am” (S2, A2), and another felt they were newly equipped to stand up to bullies “through the videos, SAMA has helped me a lot … I never would be able to handle bullying, but this year because of SAMA I don’t easily back down now. This year I am stronger. Bullying is normal for people like me and this filming by SAMA had a huge impact on my life” (A7, 029). Category 2: Experience of movie screening Adolescents reported excitement and pride about the film screenings. Excitement was due to the shared viewing with people that mattered to them: “It was an amazing experience to watch the movie with everyone else present in the room including your classmates, your teachers and your headmistress” (A9, 009), and to the anticipation of seeing oneself “centre stage”: “I was extremely excited. I was excited to hear my own voice” (A11, 009). Pride was felt: “My first impression was that I was proud of myself” (A3, 029) as “I had never done anything this official in my whole life, and it was very exciting to see the edited version” (A7, 029). “When I saw the movie, I just felt one thing. Very proud” (A10, 009). The importance of being recognised also surfaced in talk of other films they would like to make: “I want to make a movie about me. I want the world to know that I am not an anonymous person, and no one here is an anonymous person. So, everyone should show up and not hide themselves from the world. So, this world is not just meant for rich people, the poor people also should get a chance to act.” (A2, 029). Category 3: Impact of filmmaking Adolescents reported multiple ways in which they felt the impact of the project on them individually and, on their school community. First, all students felt the films helped them to better understand the broad purpose and structure of the SAMA program, exposing how much the implementation team had misjudged what adolescents’ had grasped from the program launch: “Actually, it (the films) did help us understand more about SAMA... I think this movie was a very good method of spreading awareness of what SAMA is” (A6, 029); “Before coming to the filming group, I was not really very interested…Only after coming here (to the film screening), I got to know about SAMA and that there are workshops and sessions that are going on” (A1, 009). Films also increased understanding of the SAMA lay counsellor role: “I used to think the role of the SAMA Snehitharus is just to listen to our problems and to give advice. But after seeing these films, I realised that they also help in getting solutions to the problems” (A2, 009). Second, films “added to my understanding of mental health” (A2, 029) and were seen as an effective way to raise mental health awareness in school because it was students speaking to students: “this movie was a very good method of spreading awareness of how we can deal with stress and depression, how we deal with a lot of things in adolescence” (A6, 029). Critically, it was because the films were perceived as student-to-student dialogue that they had power to influence: “when students see these videos they may be able to think that these videos are created by students and if they could come out of their problem, so can I. They may also open their heart and talk to the SAMA Snehitharus” (A3, 009); “It’s a good way for people to relate that by seeing the film, people might…seek help and support” (A6, 029). Adolescents reported that the films helped to clarify and consolidate how the intervention might help them with specific problems: “I got to know that SAMA can be of help to you even if you are being bullied and you can come out of it as well” (A7, A15, 009). Creating the films together also meant students shared mental health experiences with each other: “Also, I think being a part of SAMA (filming group) with my peers… all of us understood how well all of us can deal with stress and depression. Some of us might not have gone through it and some of us might have” (A6, 029). In discussion about what other films they might like to make, the participants also emphasised that they wanted to make more films about mental health and related aspects: “And I would also like to make a movie about bullying” (A8,029). “I would also like to make a film on bullying, depression, anxiety to highlight the problems and how they could be overcome” (A7,029); “I would like to make something like about multiple personality disorder, something like a Marvel movie” (A10, 029). Third, adolescents felt the films could be an important influence on teachers and parents who, after viewing the films, “might also think that ‘we should also bring SAMA to our school’”. Even parents may think that “even if our children hide something from us, they may share it with their teachers… the SAMA teacher” (A3, 029). The usefulness of the films to raise awareness in future imagined audiences was also noted: “a lot of times people will not listen to you. They might not have the time or interest. But filming is totally different. It’s so different so people will have interest to see this, try this and can even change by seeing this” (A3, 029). Participants suggestions for future films also revealed which parts of the intervention the adolescents wanted to explore more: “We can shoot a narrative about how the SAMA Snehitaharus will teach the students. Capturing sessions of the SAMA Snehitharu with the students” (A9, 009). Some wanted to make a film about the reality of school life: “We can show how sometimes teachers scold and that makes us feel bad. They might not have time to understand each student’s feelings” (A3, 029); “I would like to make a movie about the everyday life of a normal student…a message to the world about what are the difficulties that we go through or how we are sometimes ignored” (A8, 029). Impact event: Screening feedback The four films were screened at a SAMA in-person impact event (2024) in NIMHANS, India. Attendees (total n = 56) were education and mental health policy actors, NGO staff, headteachers and SAMA lay counsellors. Most (97%) reported the films were easy to understand with clear messages, and most (87%) felt the films helped them to understand the SAMA intervention study. When asked about the best part of the films, 41% indicated this was the importance given to youth voice, their experiences and ideas. Others valued the creative / artistic output, the involvement of school staff (e.g. being interviewed by young people) and the way the films communicated how the SAMA whole school program could help young people. The audience’s very brief analysis of the key message of the films were similar to those of the research teams in- depth analysis and included: that young people want their experiences and needs to be acknowledged, and to have help that helps (30%); that SAMA elevates mental health awareness in young people and how lay counsellors can help (17.8%); and the importance of the Speak Out box (14%). Stakeholders felt the films could be improved by being longer but should continue to focus on how the intervention impacted young people specifically and how lay counsellors practically addressed issues. 4 Discussion Participatory research with young people in India is rare despite the need for transformative action that meets their needs [ 18 , 20 ]. To advance participatory research with those communities, we report our critical enquiry into whether PV is a feasible and helpful methodology in Indian school mental health research [ 25 ], and whether it appeared to meet the standards for meaningful, equitable participation [ 50 , 51 ]. Our study established the feasibility of PV methodology with adolescents in India, when supported by researchers and with the permission and encouragement of their schools. Starting from a position of one expert (PC, based in the UK), we were able to cascade training to 17 researchers and lay counsellors in India and recruit four study schools and 56 adolescents to engage with PV on the topic of mental health in schools. None of our four main concerns were borne out. We did not encounter barriers associated with mental health stigma nor fears of school reputational damage if there are high levels of poor student mental health – worries which can be widespread in India [ 37 ]. The positive response to PV in our project may have been influenced by our use of the term ‘wellbeing’ rather than ‘mental health’, by the relationship building undertaken by lay counsellors in schools, and by our constant commitment to work in partnership with schools who would retain editorial rights on any outputs [ 35 , 52 ]. We also did not see any evidence that PV was viewed only as a youth development activity, and we did not experience rejection or criticism of PV as a colonial practice imposing western values of adolescent voice and agency. The two schools hosting the final youth filmmaking crews gave permission for film screening to relatively large (albeit in house) groups, suggesting they saw PV to amplify the voices of young people rather than purely as a creative extra-curricular activity. Stakeholders at our impact event welcomed hearing youth perspectives in film form, highlighting the potential of youth voice via PV films to land well with decision-makers in India, a common phenomenon in the literature on PV [ 28 ]. Less clear, however, was the extent to which schools and stakeholders felt held to account by the films – an issue raised by adolescent participants in [ 36 ]. As PV in our project was at an early stage, we could not track the longer-term impact of the films on those audiences. Our second research question enquired into whether PV met the standards for meaningful research participation with benefits for the adolescents. In line with much of the literature on PV [ 53 ] and resonating with the WHO’s global consensus statement on meaningful participation in research [ 54 ], PV was reported by our participants as an overwhelmingly positive experience that respected their skills, ideas, perspectives and strengths. Experiences were described as fun, exciting and interesting and some felt they had gained new skills and a new awareness of their competencies and creativity. Many reported stronger connections with peers, learning more about themselves and feeling enabled to address problems. Film screenings were reported to generate pride, challenging the view that talking about mental health is stigmatising for Indian young people. Empowerment is a widely celebrated outcome of PV with young people (e.g. 54, 55, 56, 57] but the concept is rarely defined nor measured. One exception is [ 58 ] PV project on tobacco control, where empowerment was defined as an individual’s beliefs about their capacity to influence others, including family, friends, community and the sociopolitical context, as well as their capacity to apply learning to their own health behaviours. Our data supports this. Adolescents reported pride at being able to share knowledge about lived experiences in schools, and many said they learned about mental health themselves. Their accounts also extended the concept of empowerment to being rendered visible and audible. The adolescents involved in the project valued the opportunity to ‘voice out’ their opinions, felt good about ‘hearing my own voice’ during the screenings and reported a sense of fulfilment at no longer being ‘anonymous’ in their school community. Being included in this way may have been almost impossible in a face-to-face meeting with powerful professionals. Importantly, empowerment via PV in our project was an iterative process, which seemed to be carefully monitored and judged by the young people. This began with their assessment of the training process as truly equipping them to be creative leads, whether we really meant they had narrative freedom in the storyboarding stage and whether we would see through our commitment to screen ‘their voice’. Other PV studies have similarly reported that empowerment involves feeling trusted to have complete ownership over the process and final films, with an honest transfer of power from adults to them, without subterfuge [ 55 , 59 ]. [ 60 ] additionally argues that empowerment is supported, and recognised by young people, when adults facilitate groups of young people to come together and combine their power. Our study supports this hypothesis, with our adolescents reporting how much they valued working alongside peers. With regards to the helpfulness of PV as a methodology in school mental health intervention research, we identified multiple benefits following close audio-visual analyses of the films, focus groups about the PV experience, and film screening responses. Within the rigid power structures of the Indian school system, PV provided students freedom to inhabit the school space in a very different way to how they experienced it normally. The data suggested that PV gave adolescents an opportunity to build ‘psychological ownership’ [ 61 ] of the intervention and in promoting it in their school community. PV helped the filmmakers, and those who saw the films, to understand the intervention more. Such ‘psychological ownership’ can emerge when communities: get to know the intervention, for example, by experiencing it; invest themselves in it, for example, by contributing efforts; and by having some control over the intervention, for example, by being involved in decision-making. Although we did not anticipate this, adolescents in our study used and experienced PV as a tool to build such ‘psychological ownership’; this is a key finding, as ownership, or lack of it, can significantly influence an intervention’s acceptability and ultimately effectiveness [ 62 ] and may be one reason why, globally, school mental health interventions do not generally experience much success [ 63 ]– students feel ‘done to’ rather than ‘worked with’. The films also allowed us to see adolescents’ perspectives on which intervention components were more or less important, which we could triangulate with post-intervention process evaluation data [ 64 ] to inform which intervention components could be dropped or intensified. For example, we were struck by the attention the lay counsellors attracted in the films. By seeing how adolescents were explaining the intervention to each other in the films, we could also see where there were misunderstandings, assumptions or false expectations, as well as what was working well, which we could respond to whilst the intervention was live. Such adaptive responses can support an intervention’s success [ 65 ]. The use of PV in our study also helped us to understand adolescents’ formulations of mental health and what responses they would like to see in their school. Notably, their formulations diverged from adult-centric, psycho-medical models of mental health which often situate poor adolescent mental health as a consequence of developmental changes, poor cognitive and emotional regulation, and engaging in risky behaviour [ 66 , 67 ]. While our intervention had been informed by the few available studies on Indian young people’s mental health [ 68 , 69 ] some insights and emphasises in the films were especially helpful to us. The films reminded us that school mental health interventions should be applied to everyday, typical situations affecting youth wellbeing and should contextualise poor mental health in terms of problems that happen to young people, rather than as an inevitable outcome of the adolescent stage per se. Films also emphasised to us that adolescents want to get to know a person (e.g. lay counsellor) before approaching them for help in school. They also underscored the importance of the young person being taken seriously. Furthermore, films indicated that interventions should equip adults to deliver ‘help that helps’. Particularly new to us was that interventions should support peer-led action for mental health, enabling adolescents to talk together about, and share strategies for, dominant concerns, especially bullying and managing academic stress. Such insights will be triangulated with our intervention logic models to include what young people see as mechanisms of change. The films also gave us, as researchers (many of whom were based in the UK), a sense of the implementation conditions [ 70 ] in schools from the perspectives of young people, which will enhance our interpretation and understanding of outcomes. Critiquing PV While our focus here has been to document the feasibility and helpfulness of PV as a participatory method in our school mental health research in India, we simultaneously raise critical issues around this method. First, we are not sure how inclusive our PV project was, where inclusion refers to involving a diverse range of young people, especially those who are usually excluded [ 71 ]. This is a difficult criterion to evaluate. We did not collect demographic information about our youth filmmakers beyond school grade and gender. Although any young person could opt in to our PV project, it is possible that schools proffered their best students, or that only the most gregarious and creative young people opted in. As PV projects are limited in the number of filmmaking participants they can involve (due to the capacity of facilitators and/or the amount of equipment available), claims to broad inclusion will be difficult to substantiate. We have learned that we must find out more about who comes forward for PV projects in schools, and where greater effort is needed to support typically excluded young people. Second, PV is not in and of itself a liberating, participatory methodology. Rogers (2016), who used PV with young people in alternative education settings in Canada on the topic of violence, argues that PV projects in schools can never be fully shielded from the infiltration of power inequity and dominant, privileged discourses. He was particularly troubled by the individualistic and deficit discourses which emerged from adults’ reflections on the PV project as ‘helping students better themselves’. In the films created in our projects, we were similarly troubled by the ‘back on track’ idiom taken up by students in one film (Viona is Back on Track) and by a headteacher (in the SAMA documentary). Although both were referring to being ‘back on track’ in academic work, the students’ position was that they were sent ‘off track’ by life circumstances whereas the headteacher attributed students going ‘off track’ to being distracted, with low motivation and mobile phone addiction – suggesting their need to be socially, morally and educationally reformed with an intervention like ours. The headteachers’ blaming and perpetuation of ‘individualist and deficient discourses’ in the documentary film was problematic to us, yet young people did not edit out the headteacher (who was expecting to see themselves in the film). We self-silenced to submit to the young people’s creative control here. Perhaps such improvement discourse is inevitable when PV is conducted in schools but it nonetheless alerts us to the importance of the context in which PV projects are delivered, and how these are imbued with power that can talk over the marginalised voices which PV is meant to be championing. As further evidence of the presence of power, none of the films produced by our young people challenged, or held to account, the harsh and demanding Indian education system which has been linked to high levels of adolescent stress, anxiety, depression and suicide [ 72 , 73 ]. This neglect was curious to us, as we had anticipated films about the culture of academic demand and expectation. It may be that such films were not made as this system is not visible to young people or because it is not a system that they feel they can speak about or have potential to impact – in which case, youth PV projects like ours may be inadvertently maintaining of oppressive structures. Of course, the lack of challenge about the oppressive education system may simply be due to the fact that the young people wanted to make films which showed their teachers more of their unseen problems, rather than to use PV as we had imagined (i.e. PV as an individual rather than political tool). This alerted us to how PV may be taken up by community filmmakers in ways that differ from the expectations of researchers. Third, this then raised questions about how much we ought to have presented PV to the adolescents as a potential form of political and social justice action, in line with the method’s traditional purpose. This was dilemmatic for us, i.e. how creative freedom in youth PV projects can be balanced with steering them to exploit PV for social action. Rogers (2016) was left with similar questions. We concluded that the films made by our adolescents were indeed political in the sense that they challenged the individual deficit model of mental health and made calls for well trained, youth-centred relation-based support in schools. However, we have been left wondering if even more impactful films could have been produced had we framed the PV as political, although this may have been less palatable to recruited schools. Strength and Limitations A key strength of our study lay in the commitment to, and delivery of, equitable partnerships between the India-UK team, across our train-the-trainer model, and with schools and young people; indigenous knowledge, values and practices shaped project delivery. We conducted close audio-visual readings of the films. This is a reasonably unusual approach as PV research does not typically attend to the ‘types of film text such projects produce’ and what these tell us about their producers’ perspective [ 32 ]. We secured much needed evidence about young people’s experience of this methodology, and showed how PV can be a novel and helpful method in a standard feasibility study design. Our study was limited to four Indian secondary schools in one Indian state that had opted in to Project SAMA; they are likely to have been particularly supportive of youth participatory research and welcoming of youth voice. The project could only support a small number of film crews, and the benefits of PV as reported by them may not be experienced other Indian young people with differing needs or barriers to empowerment. Although project facilitators endeavoured to hand power to the youth film crews, their roles in the SAMA intervention are likely to have inherently shaped young people’s accounts of the intervention. 5 Conclusion In the context of school mental health research, our study supports the use of PV as a meaningful participatory research practice with Indian young people. We advocate for its wider use to advance youth perspectives on how to address the significant unmet need in relation to adolescent mental health in India. We also advocate for the use of PV as a tool in intervention research, which can capture aspects of the intervention experience that are typically hidden or invisible to researchers. Notably, our study showed that PV may support psychological ownership of interventions and could be considered as an intervention mechanism. Critical reflection on the presence of power and dominant discourses should pervade all PV projects. Declarations Clinical trial number : not applicable Ethics approval and consent to participate Ethical approval has been granted by the National Institute of Mental Health Neurosciences Research Ethics Committee (NIMHANS/26th IEC (Behv Sc Div/2020/2021)) and the University of Leeds School of Psychology Research Ethics Committee (PSYC-221). This research was conducted in full accordance with the ethical principles outlined in the Declaration of Helsinki for research involving human subjects. Informed consent to participate was obtained from all of the participants in the study and informed consent was obtained from the parents or legal guardians of participants below 16 years, prior to be included in the study. Consent for publication All participants and their legal guardians provided written consent for the publication of data, including anonymised quotes and film content. Where participants appeared on camera, explicit consent for public dissemination (e.g., on YouTube and during project events) was obtained. Availability of data and materials Available from the corresponding author on reasonable request Competing interests The authors declare that they have no competing interests. Funding This work was supported by the UK’s Medical Research Council, Economic and Social Research Council, National Institute of Health Research and UK Aid (Grant number MR/T040238/1). All views expressed here are of the authors only. Authors’ contributions RN and SP: data collection, data analysis, writing - original draft; JN: supervision, writing-reviewing and editing; KH: writing-reviewing and editing; PC and SHJ: conceptualisation; data collection; data analysis; supervision; writing - original draft; writing-reviewing and editing. All authors read and approved the final manuscript. Acknowledgements We thank the schools and young people who participated in this study. We thank Jayalaxmi and Krupa and lay counsellors in schools for supporting the filmmaking process. References Schiavo R. What is true community engagement and why it matters (now more than ever). Journal of Communication in Healthcare [Internet]. 2021 Jul 19;14(2):91–2. 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Empowering young people and strengthening resilience: youth-centred participatory video as a tool for climate change adaptation and disaster risk reduction. Children’s Geographies [Internet]. 2015 Oct 31;13(3):357–71. Available from: https://www.odi.org/sites/odi.org.uk/files/resource-documents/10613.pdf Chowns G. End-of-life care discussions: but not in front of the children? End Life J. 2009;3(1):41–7. World Health Organization (WHO). Global consensus statement: Meaningful adolescent and youth engagement. Geneva: Partnership for Maternal, Newborn & Child Health;2018. Eastwood A, Juárez‐Bourke A, Herrett S, Hague A. Connecting young people with greenspaces: The case for participatory video. People and Nature. 2021 Jun 29; Piredda F, Bertolotti E, Venditti S. Masters of Ceremonies. A design approach to participatory video. The Design Journal. 2017 Jul 28;20(sup1):S3340–53. Park E, Chang YP. Digital media: Empowering adolescents for smoking prevention (preprint). JMIR Pediatrics and Parenting. 2018 Dec 5;3(1). Stevenson A, de Castañeda T, Oldfield J, Klie M. Zones of comfort and imaginability: using Participatory Video Interviewing to explore ecologies of resilience in Guatemala City. Children’s Geographies. 2022 Oct 29;1–18. Mahadev R. Making silent voices heard: Using participatory video to address sexual violence. Agenda. 2015 Jul 3;29(3):13–21. Pierce JL, Kostova T, Dirks KT. Toward a Theory of Psychological Ownership in Organizations. The Academy of Management Review. 2001 Apr;26(2):298–310. Ambuehl B, Kunwar BM, Schertenleib A, Marks SJ, Inauen J. Can participation promote psychological ownership of a shared resource? An intervention study of community-based safe water infrastructure. Journal of Environmental Psychology [Internet]. 2022 Jun 1;81:101818. Available from: https://www.sciencedirect.com/science/article/pii/S0272494422000639 Ang RP, Huan VS. Relationship between Academic Stress and Suicidal Ideation: Testing for Depression as a Mediator Using Multiple Regression. Child Psychiatry and Human Development. 2006 Jul 21;37(2):133–43. Moore G, Audrey S, Barker M, Bond L, Bonell C, Cooper C, et al. Process evaluation in complex public health intervention studies: the need for guidance. Journal of Epidemiology and Community Health [Internet]. 2013 Sep 10;68(2):101–2. Available from: https://jech.bmj.com/content/jech/68/2/101.full.pdf Viswanath K, Agha S. Adaptive Interventions to Promote Change in the 21st Century: The Responsive Feedback Approach. Global Health: Science and Practice [Internet]. 2023 Dec 18 [cited 2024 Apr 6];11(Supplement 2). Available from: https://www.ghspjournal.org/content/11/Supplement_2/e2300450.abstract Paulus FW, Ohmann S, Möhler E, Plener P, Popow C. Emotional Dysregulation in Children and Adolescents With Psychiatric Disorders. A Narrative Review. Frontiers in Psychiatry [Internet]. 2021 Oct 25;12(1). 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Available from: https://www.sciencedirect.com/science/article/pii/S016517811930602X Seale J, Nind M, Parsons S. Inclusive research in education: contributions to method and debate. International Journal of Research & Method in Education. 2014 Aug 7;37(4):347–56. Ang RP, Huan VS. Relationship between Academic Stress and Suicidal Ideation: Testing for Depression as a Mediator Using Multiple Regression. Child Psychiatry and Human Development. 2006 Jul 21;37(2):133–43. Kumar V, Talwar R. Determinants of psychological stress and suicidal behavior in Indian adolescents: a literature review. Journal of Indian Association for Child and Adolescent Mental Health. 2014 Jan;10(1):47–68. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9384591","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":631546018,"identity":"85100fc5-7d71-45d1-85d9-d6e0df3c6057","order_by":0,"name":"Ritwika Nag","email":"","orcid":"","institution":"Australian National University","correspondingAuthor":false,"prefix":"","firstName":"Ritwika","middleName":"","lastName":"Nag","suffix":""},{"id":631546019,"identity":"0f4c99cd-7b94-4610-a0eb-3f07f3d6a8b8","order_by":1,"name":"Sphoorthi Prabhu","email":"","orcid":"","institution":"NIMHANS - National Institute of Mental Health \u0026 Neurosciences","correspondingAuthor":false,"prefix":"","firstName":"Sphoorthi","middleName":"","lastName":"Prabhu","suffix":""},{"id":631546020,"identity":"8fb13b18-d743-4bc5-b886-63e080bf75b5","order_by":2,"name":"N Janardhan","email":"","orcid":"","institution":"NIMHANS - National Institute of Mental Health \u0026 Neurosciences","correspondingAuthor":false,"prefix":"","firstName":"N","middleName":"","lastName":"Janardhan","suffix":""},{"id":631546021,"identity":"90645c06-5f8f-4a8e-90bd-23ecd7c90a23","order_by":3,"name":"Kier Harris","email":"","orcid":"","institution":"University of Leeds","correspondingAuthor":false,"prefix":"","firstName":"Kier","middleName":"","lastName":"Harris","suffix":""},{"id":631546022,"identity":"4b1c076d-c3ac-454b-9412-977ee69e040c","order_by":4,"name":"Paul Cooke","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAyElEQVRIiWNgGAWjYNCCAwxyfEBKAsJjI06LMRvJWhLbiNZizsD88MGHMzbpbezNB2/+YLCTZ5BIS8CrxbKBzdhwxo203DaeY8nWPAzJhg0SaQfwajE4wMMmzfPhcG6bRI6ZNAMDcwKDRHoDMVr+p7PJv/8m+YOhnlgtNw4ksEnwABHDYaAWAg6zbAb55UyyYRtPmrE1j8FxIONZAl4t5uzNwBA7ZifPz3744c0fFdVARpoBfocxo3KJiEj8Bo6CUTAKRsEoAAEA3a47M39FrZoAAAAASUVORK5CYII=","orcid":"","institution":"University of Leeds","correspondingAuthor":true,"prefix":"","firstName":"Paul","middleName":"","lastName":"Cooke","suffix":""},{"id":631546023,"identity":"aba78412-8b92-4998-a432-37e727cc0877","order_by":5,"name":"Siobhan Hugh-Jones","email":"","orcid":"","institution":"University of Leeds","correspondingAuthor":false,"prefix":"","firstName":"Siobhan","middleName":"","lastName":"Hugh-Jones","suffix":""}],"badges":[],"createdAt":"2026-04-11 05:08:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9384591/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9384591/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108492932,"identity":"8b42b2aa-9ab3-40e5-bdbc-f604bfe138ca","added_by":"auto","created_at":"2026-05-05 09:59:00","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":274090,"visible":true,"origin":"","legend":"\u003cp\u003eThe administered PV train-the-trainer model and numbers reached\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-9384591/v1/ba4634762393e0e5281679df.png"},{"id":108803822,"identity":"d0e62a32-ba03-4ebe-9f8d-d04d908f421e","added_by":"auto","created_at":"2026-05-08 15:08:29","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":583453,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9384591/v1/f545ea78-45fb-4bf5-b219-6d8f9e123bf3.pdf"},{"id":108406980,"identity":"43adcf05-af6a-4e05-a1ca-564ea2ff1f1b","added_by":"auto","created_at":"2026-05-04 09:47:19","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":15676,"visible":true,"origin":"","legend":"","description":"","filename":"GRIPP2ShortForm.docx","url":"https://assets-eu.researchsquare.com/files/rs-9384591/v1/e7a9b5769c338d165948a049.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Rethinking the role of participatory video for school mental health interventions: insights from a feasibility study in Indian secondary schools","fulltext":[{"header":"Plain English Summary","content":"\u003cp\u003eParticipatory Video (PV) is a method where people create short films to share their own experiences, rather than being studied only through surveys or interviews. While PV is often promoted as a way to give communities a stronger voice, there is limited evidence about how well it works in low‑ and middle‑income countries, particularly with young people and sensitive issues such as mental health.\u003c/p\u003e\n\u003cp\u003eThis study explored whether PV could be used in Indian schools to help evaluate \u003cem\u003eProject SAMA\u003c/em\u003e, a school mental health programme co‑designed with communities in Karnataka, India. In this context, young people are not always encouraged to speak openly, and mental health remains stigmatised. As a result, it was uncertain whether making and sharing films would be acceptable, useful, or safe.\u003c/p\u003e\n\u003cp\u003eUsing a train‑the‑trainer approach, researchers supported 56 students aged 12–16 to learn basic filmmaking skills and create films about their school wellbeing and experiences of the SAMA programme. Four films were produced and screened in schools, at a public event, and online. Data came from audience feedback, group discussions with student filmmakers, and reflections from the research team.\u003c/p\u003e\n\u003cp\u003eThe study found that PV was both feasible and helpful. The films revealed insights into students’ school lives and mental health that were not captured by other evaluation methods. Participation also benefited students by building skills, confidence, self‑expression, and reflection, and increased their sense of engagement with the programme.\u003c/p\u003e\n\u003cp\u003eChallenges remained, particularly around adult–youth power dynamics and limited understanding of the films’ wider advocacy potential. Overall, the study shows that PV can be a valuable and engaging tool for school mental health research in India when used carefully and critically.\u0026nbsp;\u003c/p\u003e"},{"header":"1 Background","content":"\u003cp\u003eThis paper contributes to ongoing advocacy for more participatory practices in global mental health research for young people. Although not new, participatory methods continue to be encouraged in both high-(HICs) and low-and middle-income countries (LMICs) due to frustrations about the relatively low impact of some social science research and the unacceptable exclusion of community (compared to scientific) knowledge about the community\u0026rsquo;s own lives [1]. This is particularly important for groups historically marginalised from research about them and for them, including young people [2]. There are thus ongoing calls for changes to the way research and knowledge generation is conceptualised and executed [3].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eParticipatory research aims to secure voice, representation and community-led change and its ostensible benefits have been widely reported, from empowerment to a sense of belonging, to improved mental health [4, 5, 2, 6, 7]. Participatory research is also typically valued for its ability to break down power hierarchies and, in relation to youth mental health research, to highlight the ways in which adolescents can present authoritative knowledge of their own lives and experiences [8]. This is critical given the failings of adultism and adult-led models of practice [8].\u003c/p\u003e\n\u003cp\u003eOur focus is on participatory filmmaking (generally termed in the literature \u0026lsquo;participatory video\u0026rsquo;, PV), where a community creates a film to both reflect on and catalyse social transformation on an issue of importance to them [9]. Often viewed as grassroots, democratic and decolonising method, many studies report PV as highly successful [10, 11, 12, 13]. However, there are criticisms about the \u0026ldquo;mythologising of the power of participatory methodologies to accomplish problem solving, emancipation or empowerment\u0026rdquo; [14]. This criticism extends to PV, where the relative lack of critical evaluation of project outcomes raises questions about what the specific value of this form of participatory research may or may not be. A more robust evidence base is required if the field is to learn and improve [15]. In this paper, we offer a critical examination of PV as a participatory method with young people in mental health research, drawing from our use of PV in a co-design and feasibility study of a whole school mental health program in Bangalore, India. \u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eAdolescent Mental Health in India\u003c/h2\u003e\n\u003cp\u003ePoor mental health accounts for 45% of the global burden of disease in 10\u0026ndash;24-year-olds and most of this fall on young people in LMICs [16]. India is home to the largest number of adolescents worldwide [17]. Nearly 24% of Indian school-going adolescents have a mental health condition [18] and suicide is a leading cause of adolescent death [19, 20]. Despite having the greatest level of need, mental health support for adolescents globally and in India has been woefully invisible and its shoehorning into adult medico-psychiatric models of practice is frequently failing young people [21, 22]. The extent of unmet need requires radical new ways of thinking about and responding to youth mental health. McGorry et al. (2022) argue that this requires shifting our research focus to community engagement, education and consultation; youth participation, respect and co-design; prevention and early intervention; and the use of evidence-based approaches. This shift is beginning to gain traction in India but is at an early stage [23], where participatory mental health research with adolescents is rare, but growing [24, 25]. Calls for \u0026lsquo;youth voice\u0026rsquo; in research must retain vigor and urgency given the scale of the problem [2]. Our paper supports this growth through the presentation of our evidence on the potential of PV as a participatory tool to increase the effectiveness of adolescent mental health interventions in India.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eParticipatory Research: The Potential of Participatory Video\u003c/h2\u003e\n\u003cp\u003eCommunity-led filmmaking as a tool for community reflection and advocacy is generally seen as a valuable participatory methodology. The global literature indicates that PV can bring new knowledge and empathy towards an issue, often challenging assumptions and stereotypes that may be hindering progress [26, 27, 28, 7]. As audio-visual media such as film are often more accessible and impactful than written texts [29], PV is frequently seen as holding powerful communicative potential to emotively influence decision-makers at local, national and global levels in ways that other community-engagement methods might not. Moreover, participants who make films often also begin to see themselves\u003cem\u003e\u0026nbsp;\u003c/em\u003eas \u0026lsquo;agents of change\u0026rsquo; [30]. This is rarely an outcome of traditional research methods that can often appear extractive to participating communities [31]. PV films can also help to raise awareness of a project, engaging stakeholders and disseminating findings more effectively than projects without ready access to shareable audiovisual material [32].\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eProject Sama: The Critical Challenge of PV\u003c/h2\u003e\n\u003cp\u003eIn India, a small number of PV projects have been conducted with children and adolescents including children with disabilities [33], street children [34], and youth at risk of substance-use disorders [32]. There are no published studies on the use of PV in adolescent mental health research in India. We opted to use PV in our study, Project SAMA (Safeguarding Adolescent Mental Health in India), a Community-Based Participatory Research (CBPR) [35] study to co-design and feasibility test a whole school mental health intervention for adolescent wellbeing in Bangalore. We hoped to engage adolescents in PV as a platform for them to articulate what matters in terms of their wellbeing in school and their experience of our co-designed whole school intervention. We hoped that the created films would first be powerful and direct youth communication to decision-makers regarding mental health in Indian secondary schools and second, would provide additional research insights to supplement our standard intervention effectiveness data [25]. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHowever, whether PV would be a feasible methodology in our context was unclear. While the tone of the literature on PV is overwhelmingly positive, PV does not always succeed. \u0026nbsp;[36], for example, report on a failed attempt to use PV with a LGBTQIA+ community experiencing homelessness in New Zealand which reinforced rather than subverted power dynamics. One participant stated: \u0026ldquo;it doesn\u0026apos;t feel like participatory or like a partnership at all. It feels like academics have chosen and stuck with a method that the community doesn\u0026rsquo;t want\u0026rdquo; (p6). A further barrier in Fraser et al.\u0026rsquo;s study was that participants, who already felt stigmatised and vulnerable, sought invisibility not visibility via filming. This was pertinent to our project given the high stigma attached to mental health in India, and the vulnerability young people may feel in speaking \u0026lsquo;visibly\u0026rsquo; [37]. \u0026nbsp;A second uncertainty for us in using PV was that it could be perceived as a colonial practice encouraging western values around adolescent voice and agency that are inappropriate in the Indian school system [38]. Risks are often intensified when PV projects are co-led across countries; in our case, the UK (a former colonial power) documenting youth mental health in India might be seen as a colonial gesture rather than one that served a true local appetite for participatory research [39]. \u0026nbsp;Given the scarcity of youth participatory research in India, there were also risks that PV might be considered solely as a youth-development activity. Finally, when young people are invited to make films about their mental health, there is a risk of exposing systemic problems that are uncomfortable for stakeholders, creating tensions around reputational damage and who is held to account (as was experienced in [36]). PV cannot in and of itself escape established power dynamics and may even play out the very power dynamics the method ostensibly seeks to challenge [40]. \u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eAims\u003c/h2\u003e\n\u003cp\u003eTo understand the potential and challenges of using PV in Indian school mental health research, (Project SAMA), we examined two interrelated questions:\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003e\u003cem\u003eIs PV a feasible and helpful methodology for school mental health research in India?\u0026nbsp;\u003c/em\u003eFor PV to be considered feasible, we set a target (as is routine in feasibility studies, [41]) that we should be able to: train a core group of Indian researchers in PV to the level of being able to produce a basic film and train others to do the same; engage and get consent for at least two of the SAMA study schools and ten young people to make a minimum of two films; and secure permission to screen the films in those schools. For PV to be considered helpful for intervention research, we wanted PV to generate new youth-centered insights on adolescent mental health in India and on our intervention.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003e\u003cem\u003eDoes PV benefit young people directly?\u0026nbsp;\u003c/em\u003eThe WHO\u0026rsquo;s \u003cem\u003eGlobal Consensus Statement\u003c/em\u003e defines meaningful youth participation in research as \u0026ldquo;an inclusive, intentional, mutually respectful partnership between adolescents, youth, and adults whereby power is shared, respective contributions are valued, and young people\u0026rsquo;s ideas, perspectives, skills, and strengths are integrated into [outcomes]\u0026rdquo; [42]. We examined whether our use of PV could meet this standard.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"2 Methods","content":"\u003cp\u003ePV was a workstream of Project SAMA which was a 3-year research collaboration between the National Institute of Mental Health and Neurosciences (NIMHANS), the Universities of Leeds, Birmingham, Oxford and the London School of Hygiene and Tropical Medicine in the United Kingdom (UK). It was funded by the UK\u0026rsquo;s Medical Research Council, National Institute of Health Research, UK Aid and the Economic and Social Research Council. Whilst there are many school programs in India to support youth in life skills [43], there was no whole school program in India which worked across actors and systems to promote protective factors (e.g. positive relationships) and reduce risk factors (e.g. punitive teacher practices). The project\u0026rsquo;s main aim was to co-design and feasibility test a whole school program to support adolescent wellbeing in secondary schools, with the primary aim of reducing symptoms of anxiety and depression.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFollowing a systematic review of global literature to identify candidate whole school programs, or components of them [44], we conducted 15 co-design workshops with adolescents, educators, parents and mental health professionals in the state of Karnataka (in the regions of Bengaluru, Bangarpet and Kolar). The final designed intervention had components targeting adolescent mental health literacy and capacity for self-care, teacher mental health literacy and capacity for positive discipline practices, school climate (including reduction of bullying) and parent mental health literacy. Lay counsellors (called SAMA Sneitharus - the Kannada word for friends) were recruited, trained and embedded in schools for between 6-8 months to deliver the intervention and provide support to students and staff in implementing SAMA. Our primary purpose was to examine intervention feasibility, and we tested this in five intervention schools and three waitlist schools [25].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOur plan was to use PV in the study schools to create adolescent-led films that highlighted participants\u0026rsquo; everyday experience of school, how it influenced their mental health and their experience of the SAMA intervention. The SAMA team included a highly experienced participatory filmmaker (PC) who has worked with adolescents globally on challenging issues, from the experience of undocumented children in South Africa to the impact of substance use on young people in India [45, 32].\u003c/p\u003e\n\u003ch2\u003ePV Method\u003c/h2\u003e\n\u003cp\u003eOur approach to PV was grounded in a method summarized in Shaw and Robertson [46, 47, 48] who provide four widely accepted ground rules for PV projects. These are that: all participants take turns in a variety of production roles and roles are rotated regularly; all participants who want to can perform in front of the camera each session; all video material is played back to participants after each session; and video recordings are confidential and only shown externally if all participants agree [47].\u003c/p\u003e\n\u003ch4\u003eStep 1: Train the trainer model\u003c/h4\u003e\n\u003cp\u003eWe adopted a train-the-trainer model, cascading knowledge and capacity for PV across the SAMA Indian research team (based in NIMHANS), then to lay counsellors based in study schools and then to early career researchers (ECRs). As per global agendas for capacity building [49], our train-the-trainer model aligned with a project commitment to build in-country capacity for new research methodologies. Work began with a series of train-the-trainer online workshops facilitated by PC for a core team of SAMA project staff in NIMHANS on the basics of film production (e.g. using the camera, framing shots, sound recording, telling a compelling story, and basic editing skills). Following training, the SAMA team developed a manual to guide their approach to working with adolescents (Training Young People in Filmmaking). This included plans for six workshops that take participants through the steps of developing, producing and screening a film in, and with, their community. The manual built on one produced in an earlier project led by PC (Community Arts for Antibiotic Resistance across Nepal), which used PV to support communities in finding appropriate solutions to the misuse of antibiotics [32].\u0026nbsp;\u003c/p\u003e\n\u003ch4\u003eStep 2: Recruiting PV Participants\u003c/h4\u003e\n\u003cp\u003eWe recruited adolescents from schools participating in the SAMA intervention study via announcements made by lay counsellors. Adolescents were informed that taking part would: (i) require parental permission and personal consent, following reading of the full study information letter; (ii) involve attending film workshops on school premises with other young people, researchers and filmmakers to create short films to help viewers understand what affects adolescent well-being in school; and (iii) that they could decide if they wanted to use their own name and/or appear on camera.\u0026nbsp;\u003c/p\u003e\n\u003ch4\u003eStep 3: Creating films\u0026nbsp;\u003c/h4\u003e\n\u003cp\u003eFilm workshops took place on school premises supported by an Indian SAMA researcher (trained in PV) and the lay counsellor embedded in the schools. The film workshops were conducted over 1-2 days in the schools following the steps outlined in Table 1.\u003c/p\u003e\n\u003cp\u003eTable 1: Steps in filmmaking in schools 1 and 2\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eStep\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 482px;\"\u003e\n \u003cp\u003eTasks\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eLearning the basics of film production\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 482px;\"\u003e\n \u003cp\u003eParticipants were taught to use the camera, frame shots, record sound, how to tell a compelling story, different modes of telling a story (documentary versus fiction filmmaking; animation versus live action) and basic editing skills. A \u0026lsquo;learning by doing\u0026rsquo; approach was adopted: participants would try an activity and discuss what went well and what could be improved.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eCollaborative script development\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 482px;\"\u003e\n \u003cp\u003eFacilitators made clear that the film should relate to their wellbeing in school and /or their experience of SAMA, but that they could choose their focus. Once chosen, work began on idea generation, thinking about the potential audience for the films and how they could tailor their story to reach this audience. This was followed by consensus-building exercises, storyboarding and possible scenes to shoot.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eImplementation of the script\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 482px;\"\u003e\n \u003cp\u003eInput from each participant was sought to finalise the \u0026lsquo;shooting script\u0026rsquo;. Participants selected locations. Trainers helped to ensure that the group remained silent when filming and facilitated the engagement of teachers and other staff as interviewees in some of the films.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eEditing and reflective analysis of the films\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 482px;\"\u003e\n \u003cp\u003eAfter an hour of filming, each group watched what they had recorded on a wall in the classroom. Adolescents were asked to reflect on the content and shooting and what they would like to see in the final film and what kind of emotional \u0026lsquo;feel\u0026rsquo; they wished to present. In school 1 there was limited availability of software on site for editing. Therefore, this was primarily undertaken by SAMA staff, in accordance with the adolescent-generated storyboards and shooting scripts. Participants were consulted on a rough cut and the final edit. In School 2 students edited the films on their own, with the rest of the group collaborating in discussion of the edit, as well as the use of music and the overall design of the film. \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003ch4\u003eStep 4: Film Screenings\u003c/h4\u003e\n\u003cp\u003eEach participating school screened their films with the permission of the filmmakers and the support of the SAMA team, who facilitated discussion post-screening. Films were also uploaded to our project YouTube channel and shown at a project impact event.\u0026nbsp;\u003c/p\u003e\n\u003ch4\u003eData collection and analysis\u003c/h4\u003e\n\u003cp\u003eWe addressed our research questions by drawing on different data types as summarised in Table 2.\u003c/p\u003e\n\u003cp\u003eTable2: Data used to address our research questions\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"642\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Research Question\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 438px;\"\u003e\n \u003cp\u003eData\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003ePV completion rates\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eFilm analysis\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003eImpact event stakeholder responses\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003eFocus groups (n= 31)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003eResearch team reflective practice\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e1.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eIs PV a feasible and helpful methodology for school mental health research in India?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026uuml;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026uuml;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026uuml;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026uuml;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026uuml;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e2.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eDoes PV benefit young people directly, supporting equitable research?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026uuml;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026uuml;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026uuml;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTo examine research question one, we assessed outcomes against our feasibility targets. To explore whether PV was a \u0026lsquo;helpful\u0026rsquo; methodology, we drew upon film analysis, adolescent focus groups, impact stakeholder responses and our team reflective practice. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFilms were analysed using reflexive thematic analysis (RTA, Braun \u0026amp; Clarke, 2019). Step one of RTA involved multiple viewings of the films as a project team (n=9), spanning Indian and UK research expertise in psychology, clinical psychology, social psychiatry, film studies, PV and school mental health. We discussed scenes, characters and overarching narratives with a focus on what the films revealed about adolescent mental health and our school intervention. To attend to multiple dimensions of the films, we used a range of stimulus questions exploring: (i) the visual aspects of film (e.g. how the camera captured the environment); (ii) audio (e.g. what is the sound doing in the film: is it diegetic or non-diagetic and how does this change our understanding?), (iii) narrative (who or what is in the film, who is missing that we might expect, what are the possible latent and semantic meanings?); and (iv) editing (e.g. how is the story put together, what is the pace of the film and how do transitions shape the story?). We generated notes from Step 1 which helped orientation for Step 2 of RTA. This involved two researchers independently conducting line-by-line open coding of the films as audio-visual \u0026lsquo;texts\u0026rsquo; (Point and Baruch, 2023), discussing and agreeing final codes and, in Step 3, generating initial themes. These were brought for review by the project team involved in Step 1. Our aim here was to refine and define themes (Steps 4-5).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWe also examined research question one at a SAMA Impact event in India (2024) where we invited attendees to anonymously complete a questionnaire (Appendix 2) which asked: According to you, was the film easy to understand?; Did the film help you understand more about SAMA?; What for you was the best part of the film?; What for you was the key message of the film?; What do you think could have been done differently in in the film? Responses were content analysed.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTo explore aspects of research questions one and two, we conducted focus groups with the adolescent filmmakers. School, parent and individual consent had been secured for this at the point of PV recruitment. Focus groups, reaching n= 31 adolescents were conducted separately on site in the government and private school immediately after the film screening in their schools. The discussion was scaffolded by a question guide (Appendix 1) designed to help adolescents share experiences, insights and challenges encountered during the PV process. Discussions were video recorded with consent, transcribed verbatim and subjected to a basic thematic analysis conducted independently by two SAMA research staff. Steps included data familiarisation, line-by-line coding, generating preliminary themes, and refining final themes. The coders agreed the final themes.\u0026nbsp;\u003c/p\u003e"},{"header":"3 Results","content":"\u003cp\u003eWe present the results of our study under our two research questions.\u003c/p\u003e \u003cp\u003eQuestion One: Is PV a feasible and helpful methodology for school mental health research in India?\u003c/p\u003e \u003cp\u003eFeasibility was established via a train-the-trainer model (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). We met our feasibility threshold of training a core group of Indian professionals (n\u0026thinsp;=\u0026thinsp;17) in PV to the level of being able to produce a basic film and use the SAMA manual to train adolescents. Four study schools consented to take part, exceeding our target of two. We recruited and trained n\u0026thinsp;=\u0026thinsp;56 young people, exceeding our target of 10. Of these, 25 were not available at the time of PV launch in their school (due to exams, school trips etc). For the film team, 20 were recruited from school 1 (rural government school, co-education, English medium of instruction) and 11 were from school 2 (urban private school, co-education, English medium of instruction). Ages ranged from 12\u0026ndash;16 years (males) and 13\u0026ndash;16 years (females). Both schools had completed the youth-focused, classroom component of the SAMA intervention but other intervention components (school climate, teacher and parent components) were ongoing when PV was initiated. Four films were produced, exceeding our target of two.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e We met our target of securing permission to screen the films in at least two study schools. School 1 screened the films in a special event attended by students, teachers and the headteacher (total n\u0026thinsp;=\u0026thinsp;80). School 2 screened the film in a school assembly attended by students, teachers and the headteacher (total n\u0026thinsp;=\u0026thinsp;150). Films were uploaded to our YouTube channel, accompanied by a question to help viewers reflect on the films and how they might relate to their own context. To date, films have attracted around 500 views.\u003c/p\u003e \u003cp\u003e \u003cem\u003eFilm analysis\u003c/em\u003e \u003c/p\u003e \u003cp\u003eThat PV was a \u0026lsquo;helpful methodology\u0026rsquo; (part of research question one) was established via six themes, generated from analysis of the four created films. Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e summarises the film content, linked to themes, which captured important insights about how the young people see mental health difficulties arising, their experiences of this and how they might try to find resolution of difficulties. Themes were: \u003cem\u003e(1) Trouble and stress leads to poor mental health.\u003c/em\u003e Young people conveyed that feeling troubled and distressed as their phenomenology of mental health; (\u003cem\u003e2) It\u0026rsquo;s about what\u0026rsquo;s happened to me.\u003c/em\u003e This conveyed that distress emerges from things that happen to young people and not from internal dysfunction or deficiency; \u003cem\u003e(3) Just cope alone\u003c/em\u003e. Adolescents are likely to try to cope for a long time on their own without seeking help; \u003cem\u003e(4) Nothing can be done.\u003c/em\u003e Films conveyed that adolescents often do not see anything obvious that they can do to overcome their difficulties; \u003cem\u003e(5) When others notice\u003c/em\u003e. Other people noticing they are not okay is important; and \u003cem\u003e(6) Relational safety and validation.\u003c/em\u003e Adolescents conveyed that they need a safe relational space, in which they are taken seriously, as a first step towards unlocking internal and external resources to cope. Validation comes with \u0026lsquo;help that helps\u0026rsquo; and includes practical action.\u003c/p\u003e \u003cp\u003eFilms also revealed youth perspectives on the SAMA intervention which differed from those of the research team in four main ways (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). These allow us to examine how PV might be a \u0026lsquo;helpful\u0026rsquo; methodology to enable our intervention development and school intervention research more generally. First, the intervention was perceived differently by adolescents compared to teachers or the research team as intervention designers. Adolescents focused on the need for \u0026lsquo;something\u0026rsquo; in school to help them feel taken care of emotionally, whereas SAMA designers and school staff conceived of the intervention as a way to advance students\u0026rsquo; mental health literacy and potential for self-care. Second, for adolescents, the lay counsellor component was centre stage in its importance and helpfulness. Although this role was planned-by-design, we did not anticipate this component trumping all others (e.g., psychoeducation, positive classroom practices). Sharing problems with a lay counsellor was presented as providing the relational space for empathy followed by practical guidance, formulated as the \u0026lsquo;perfect mix\u0026rsquo; by students. Third, the very simple Speak Out box was a more significant intervention component for adolescents than we anticipated; it provided easy, private access to a lay counsellor and removed the pressure from students to initiate contact via a face-to-face conversation. The films underscored for us the importance of enhancing this intervention element in future iterations. Finally, students perceived the intervention as giving them a platform for youth action, and the importance of this for peer-to-peer dialogue about things that are troubling them. Without the intervention, students did not see any other obvious form of, or route to encourage, youth-led action. We had envisaged the peer roles as an important way to liaise with the lay counsellor but did not anticipate they would feel empowered to take action themselves on issues such as bullying. Further insights into the helpfulness of PV for intervention research are reported under the focus groups analysis in the next section.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDetails of the four films produced by adolescents and analysis of their representation of mental health and the SAMA whole school intervention.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTitle\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDuration and form\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDescription\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWhat do the films tell us about adolescents\u0026rsquo; views of mental health?\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eWhat do the films tell us about adolescents\u0026rsquo; view of SAMA?\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSAMA and Us\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7min 56 sec\u003c/p\u003e \u003cp\u003eDocumentary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAdolescents were invited to make a film reflecting on SAMA in their school. They began with what they valued about the program before interviewing their lay counsellor, a teacher and the head teacher. They highlighted aspects of SAMA they considered to be the most important.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1. Poor mental health arises for adolescents from having many life problems (compared to teachers who feel adolescence as a problematic age). (Themes 1 \u0026amp; 2)\u003c/p\u003e \u003cp\u003e2. Not being able to share problems (because of the lack of empathic adults) gives rise to mental health difficulties. (Theme 1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1. Students have different views of the need for, and mechanisms of SAMA, compared to staff.\u003c/p\u003e \u003cp\u003e2. SAMA fills a need for adolescents to feel taken care of emotionally in school. (Theme 6)\u003c/p\u003e \u003cp\u003e2. The lay counsellor is the \u0026lsquo;centre stage\u0026rsquo; element of SAMA for students. (Theme 6)\u003c/p\u003e \u003cp\u003e3. The Speak Out box removes the challenge of initiating a direct approach to a lay counsellor and is a critical mechanism to make help-seeking easier.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eViona is back on track\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 min 34sec\u003c/p\u003e \u003cp\u003eAnimation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eExplores the stress felt by its protagonist, Viona, as she lives with serious difficulties at home. SAMA is presented as a useful programme to help her address this pressure, to overcome her mental health problems and to get \u0026ldquo;back on track\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1. Good adolescent mental health is indicated via relational, social and academic stability.\u003c/p\u003e \u003cp\u003e2. Adolescent mental health is affected first by external events which become internal events. (Theme 2)\u003c/p\u003e \u003cp\u003e3. Adolescents can pretend they are okay despite being \u0026lsquo;broken\u0026rsquo; inside. (Theme 3)\u003c/p\u003e \u003cp\u003e4. Distress can take time to seep out and be visible to others in school. (Theme 5)\u003c/p\u003e \u003cp\u003e5. Adolescent distress needs a relational solution followed by a practical solution. (Theme 6)\u003c/p\u003e \u003cp\u003e6. There is often no obvious relationship for adolescents to experience help in school. (Theme 4)\u003c/p\u003e \u003cp\u003e7. A focus on \u0026lsquo;what is happening to you\u0026rsquo; is important to adolescents (vs what is wrong with you). (Theme 2)\u003c/p\u003e \u003cp\u003e8. Via \u0026lsquo;helps that helps\u0026rsquo;, good mental health can be restored despite ongoing life circumstances. (Theme 6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1. That SAMA was the only obvious form of help (to the story character).\u003c/p\u003e \u003cp\u003e2. There is tension between wanting and fearing help-seeking in SAMA due to potential stigma.\u003c/p\u003e \u003cp\u003e3. Having multiple ways to access help is important in school.\u003c/p\u003e \u003cp\u003e4. The Speak Out box was important for ease and privacy.\u003c/p\u003e \u003cp\u003e5. Lay counsellors are a relational space to provide empathy and guidance to handle emotions and situations.\u003c/p\u003e \u003cp\u003e6. Sharing problems with the lay counsellors stimulates recovery and problem resolution.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAryan Vs the Bullies:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 min 45 sec\u003c/p\u003e \u003cp\u003eAnimation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThe impact of several months of bullying on quiet Aryan, who did not know how to handle this and whose academic life and wellbeing was deteriorating rapidly. How SAMA peer and lay counsellor components provided a route to empower Aryan to address the bullying. Without this, his mental health trajectory would be \u0026lsquo;ruined\u0026rsquo;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1. Bullying is a known harm in schools that affects vulnerable students in extreme ways. (Theme 2)\u003c/p\u003e \u003cp\u003e2. Adolescent mental health is affected first by external events which become internal events. (Theme 2)\u003c/p\u003e \u003cp\u003e3. Adolescent distress needs a relational solution followed by a practical solution. (Theme 6)\u003c/p\u003e \u003cp\u003e4. There is often no obvious relationship for adolescents to experience help in school. (Theme 4)\u003c/p\u003e \u003cp\u003e5. A focus on \u0026lsquo;what is happening to you\u0026rsquo; is important to adolescents (vs what is wrong with you). (Theme 2)\u003c/p\u003e \u003cp\u003e6. Bullying must be eradicated to protect adolescent mental health. (Theme 2)\u003c/p\u003e \u003cp\u003e7. Via \u0026lsquo;helps that helps\u0026rsquo;, good mental health can be restored and even enhanced. (Theme 6)\u003c/p\u003e \u003cp\u003e8. Restoration of mental health does not always need psychological input. (Theme 6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1. Peer mediators can take action for vulnerable students who may not be able to do so themselves.\u003c/p\u003e \u003cp\u003e2. When given power to influence, adolescents will take immediate action against bullying of their peers.\u003c/p\u003e \u003cp\u003e3. Routes to engage with adults in school are crucial to trigger helps that helps.\u003c/p\u003e \u003cp\u003e4. Being taken seriously and being involved in decisions are critical steps towards being empowered to address bullying\u003c/p\u003e \u003cp\u003e5. SAMA provided routes to being taken seriously and routes to action.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHandling stress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 min 20 sec\u003c/p\u003e \u003cp\u003eLive-action fictional film\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eClose up of the adolescent experience. The adolescents show how the academic journey of a student is often accompanied by the significant, but frequently overlooked challenge, of stress. Stress may appear in the form of academic pressure, social pressures or extracurricular overload. The film suggests that the stress faced by adolescents in schools can have profound effects on their mental health, academic performance, and overall well-being and how it is important to give students the support to overcome these challenges.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1. Stress emerges from pressure placed on adolescents in schools. (Themes 1 and 2)\u003c/p\u003e \u003cp\u003e2. Not talking adolescent stress seriously is a risk for their mental health. (Theme 3)\u003c/p\u003e \u003cp\u003e3. Mental health is supported by responsive action. (Theme 6)\u003c/p\u003e \u003cp\u003e4. With encouragement, students want to play a central role in promoting mental health in schools themselves.\u003c/p\u003e \u003cp\u003e5. Having strategies to manage stress can help mental health. (Theme 1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1. The lay counsellor is available, open, validating and invited \u0026lsquo;working together\u0026rsquo; on managing stress.\u003c/p\u003e \u003cp\u003e2. SAMA (via the lay counsellor relationship) gives students a platform to drive forward their own action on adolescent mental health in school.\u003c/p\u003e \u003cp\u003e3. Students involved in leading school mental health activities experience personal benefits and a sense of pride.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eQuestion Two: Does PV benefit young people directly, in an inclusive and non-extractive way?\u003c/p\u003e \u003cp\u003eThat we recruited participants identifying as male (n\u0026thinsp;=\u0026thinsp;18) and female (n\u0026thinsp;=\u0026thinsp;13) suggests the methodology appeals to both adolescent boys and girls. Collaboration and inclusive participation from all involved were evident, although boys tended to be more interested in technical aspects (e.g. handling the camera, editing) and girls more interested in writing scripts, acting or narrating. Analysis of the focus group discussions helped us to understand adolescents\u0026rsquo; experiences across four topic categories, summarised below with illustrative quotations tagged by school (S) and adolescent id (A).\u003c/p\u003e \u003cp\u003e \u003cem\u003eCategory 1: Experience of filmmaking\u003c/em\u003e \u003c/p\u003e \u003cp\u003eThe relatively short, basic training in PV provided by the SAMA team, supported by lay counsellors, appeared fit-for-purpose, making them feel equipped to execute the filming relatively quickly. Adolescents described the training as \u0026ldquo;awesome\u0026rdquo; (S2, A3) and \"very exciting\u0026rdquo; (S2, A2). Hands-on, interactive training was especially welcomed by the adolescents: \u0026ldquo;on the second day we had a recap of the parts of the camera and the tripod and stands. It was very helpful...it was very interactive, I loved it a lot\u0026rdquo; (S2, A7).\u003c/p\u003e \u003cp\u003eTaking part in PV was reported to be an extremely positive experience in four main ways. First, the experience was described as novel and \u0026ldquo;cool\u0026rdquo;: \u0026ldquo;We got opportunities to act and do new things and discover stuff.\u0026rdquo; (S2, A7) and \u0026ldquo;it was the first time I ever held a camera in my hand so that was like really cool.\u0026rdquo; (S2, A9). Second, PV was consistently described as fun, often attributed to the fact that they were filming with peers (\u0026ldquo;It was fun shooting and acting with my friends\u0026rdquo; (S2, A8) and because they had freedom on the school site: \u0026ldquo;My favourite part honestly was running around the school\u0026hellip;we all had a lot of fun!\u0026rdquo; (S2, A10). Fun was also reported because of a type of flow or absorption in the task: \u0026ldquo;I forgot everything else. It was a fun experience.\u0026rdquo; (S2, A10); \u0026ldquo;I had fun editing also and the experience was so good\u0026rdquo; (S2, A3).\u003c/p\u003e \u003cp\u003eThird, several participants reported a positive experience because of new insights into themselves. For some, this was because they did things that they had not expected they could do (\u0026ldquo;the entire filming process helped us discover new things in ourselves\u0026rdquo; (S1, A10); \u0026ldquo;I had never expected that I would be on screen...that I would be able to contribute to mental health awareness\u0026rdquo; (A2, 029). A new awareness of personal competence was experienced by some: \u0026ldquo;I felt efficient\u0026rdquo; (S2, A1); \u0026ldquo;We came to know that we are good directors, and illustrators and can do so much more\u0026rdquo; (S1, A10).\u003c/p\u003e \u003cp\u003eFourth, PV was described as positive because it was experienced as a unifying experience among the adolescents: \u0026ldquo;I like the way we all came together. All of us did teamwork and I really appreciate it\u0026rdquo; (S2, A6). They also felt that SAMA had \u0026ldquo;given each one of us a chance to voice out our opinions\u0026rdquo; (A6,029). One participant reported a profound impact: \u0026ldquo;This filming workshop by SAMA helped me recognise who I am\u0026rdquo; (S2, A2), and another felt they were newly equipped to stand up to bullies \u0026ldquo;through the videos, SAMA has helped me a lot \u0026hellip; I never would be able to handle bullying, but this year because of SAMA I don\u0026rsquo;t easily back down now. This year I am stronger. Bullying is normal for people like me and this filming by SAMA had a huge impact on my life\u0026rdquo; (A7, 029).\u003c/p\u003e \u003cp\u003e \u003cem\u003eCategory 2: Experience of movie screening\u003c/em\u003e \u003c/p\u003e \u003cp\u003eAdolescents reported excitement and pride about the film screenings. Excitement was due to the shared viewing with people that mattered to them: \u0026ldquo;It was an amazing experience to watch the movie with everyone else present in the room including your classmates, your teachers and your headmistress\u0026rdquo; (A9, 009), and to the anticipation of seeing oneself \u0026ldquo;centre stage\u0026rdquo;: \u0026ldquo;I was extremely excited. I was excited to hear my own voice\u0026rdquo; (A11, 009). Pride was felt: \u0026ldquo;My first impression was that I was proud of myself\u0026rdquo; (A3, 029) as \u0026ldquo;I had never done anything this official in my whole life, and it was very exciting to see the edited version\u0026rdquo; (A7, 029). \u0026ldquo;When I saw the movie, I just felt one thing. Very proud\u0026rdquo; (A10, 009). The importance of being recognised also surfaced in talk of other films they would like to make: \u0026ldquo;I want to make a movie about me. I want the world to know that I am not an anonymous person, and no one here is an anonymous person. So, everyone should show up and not hide themselves from the world. So, this world is not just meant for rich people, the poor people also should get a chance to act.\u0026rdquo; (A2, 029).\u003c/p\u003e \u003cp\u003e \u003cem\u003eCategory 3: Impact of filmmaking\u003c/em\u003e \u003c/p\u003e \u003cp\u003eAdolescents reported multiple ways in which they felt the impact of the project on them individually and, on their school community. First, all students felt the films helped them to better understand the broad purpose and structure of the SAMA program, exposing how much the implementation team had misjudged what adolescents\u0026rsquo; had grasped from the program launch: \u0026ldquo;Actually, it (the films) did help us understand more about SAMA... I think this movie was a very good method of spreading awareness of what SAMA is\u0026rdquo; (A6, 029); \u0026ldquo;Before coming to the filming group, I was not really very interested\u0026hellip;Only after coming here (to the film screening), I got to know about SAMA and that there are workshops and sessions that are going on\u0026rdquo; (A1, 009).\u003c/p\u003e \u003cp\u003eFilms also increased understanding of the SAMA lay counsellor role: \u0026ldquo;I used to think the role of the SAMA Snehitharus is just to listen to our problems and to give advice. But after seeing these films, I realised that they also help in getting solutions to the problems\u0026rdquo; (A2, 009).\u003c/p\u003e \u003cp\u003eSecond, films \u0026ldquo;added to my understanding of mental health\u0026rdquo; (A2, 029) and were seen as an effective way to raise mental health awareness in school because it was students speaking to students: \u0026ldquo;this movie was a very good method of spreading awareness of how we can deal with stress and depression, how we deal with a lot of things in adolescence\u0026rdquo; (A6, 029). Critically, it was because the films were perceived as student-to-student dialogue that they had power to influence: \u0026ldquo;when students see these videos they may be able to think that these videos are created by students and if they could come out of their problem, so can I. They may also open their heart and talk to the SAMA Snehitharus\u0026rdquo; (A3, 009); \u0026ldquo;It\u0026rsquo;s a good way for people to relate that by seeing the film, people might\u0026hellip;seek help and support\u0026rdquo; (A6, 029). Adolescents reported that the films helped to clarify and consolidate how the intervention might help them with specific problems: \u0026ldquo;I got to know that SAMA can be of help to you even if you are being bullied and you can come out of it as well\u0026rdquo; (A7, A15, 009).\u003c/p\u003e \u003cp\u003eCreating the films together also meant students shared mental health experiences with each other: \u0026ldquo;Also, I think being a part of SAMA (filming group) with my peers\u0026hellip; all of us understood how well all of us can deal with stress and depression. Some of us might not have gone through it and some of us might have\u0026rdquo; (A6, 029). In discussion about what other films they might like to make, the participants also emphasised that they wanted to make more films about mental health and related aspects: \u0026ldquo;And I would also like to make a movie about bullying\u0026rdquo; (A8,029). \u0026ldquo;I would also like to make a film on bullying, depression, anxiety to highlight the problems and how they could be overcome\u0026rdquo; (A7,029); \u0026ldquo;I would like to make something like about multiple personality disorder, something like a Marvel movie\u0026rdquo; (A10, 029).\u003c/p\u003e \u003cp\u003eThird, adolescents felt the films could be an important influence on teachers and parents who, after viewing the films, \u0026ldquo;might also think that \u0026lsquo;we should also bring SAMA to our school\u0026rsquo;\u0026rdquo;. Even parents may think that \u0026ldquo;even if our children hide something from us, they may share it with their teachers\u0026hellip; the SAMA teacher\u0026rdquo; (A3, 029). The usefulness of the films to raise awareness in future imagined audiences was also noted: \u0026ldquo;a lot of times people will not listen to you. They might not have the time or interest. But filming is totally different. It\u0026rsquo;s so different so people will have interest to see this, try this and can even change by seeing this\u0026rdquo; (A3, 029).\u003c/p\u003e \u003cp\u003eParticipants suggestions for future films also revealed which parts of the intervention the adolescents wanted to explore more: \u0026ldquo;We can shoot a narrative about how the SAMA Snehitaharus will teach the students. Capturing sessions of the SAMA Snehitharu with the students\u0026rdquo; (A9, 009). Some wanted to make a film about the reality of school life: \u0026ldquo;We can show how sometimes teachers scold and that makes us feel bad. They might not have time to understand each student\u0026rsquo;s feelings\u0026rdquo; (A3, 029); \u0026ldquo;I would like to make a movie about the everyday life of a normal student\u0026hellip;a message to the world about what are the difficulties that we go through or how we are sometimes ignored\u0026rdquo; (A8, 029).\u003c/p\u003e \u003cp\u003e \u003cem\u003eImpact event: Screening feedback\u003c/em\u003e \u003c/p\u003e \u003cp\u003eThe four films were screened at a SAMA in-person impact event (2024) in NIMHANS, India. Attendees (total n\u0026thinsp;=\u0026thinsp;56) were education and mental health policy actors, NGO staff, headteachers and SAMA lay counsellors. Most (97%) reported the films were easy to understand with clear messages, and most (87%) felt the films helped them to understand the SAMA intervention study. When asked about the best part of the films, 41% indicated this was the importance given to youth voice, their experiences and ideas. Others valued the creative / artistic output, the involvement of school staff (e.g. being interviewed by young people) and the way the films communicated how the SAMA whole school program could help young people. The audience\u0026rsquo;s very brief analysis of the key message of the films were similar to those of the research teams in- depth analysis and included: that young people want their experiences and needs to be acknowledged, and to have help that helps (30%); that SAMA elevates mental health awareness in young people and how lay counsellors can help (17.8%); and the importance of the Speak Out box (14%). Stakeholders felt the films could be improved by being longer but should continue to focus on how the intervention impacted young people specifically and how lay counsellors practically addressed issues.\u003c/p\u003e"},{"header":"4 Discussion","content":"\u003cp\u003eParticipatory research with young people in India is rare despite the need for transformative action that meets their needs [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. To advance participatory research with those communities, we report our critical enquiry into whether PV is a feasible and helpful methodology in Indian school mental health research [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], and whether it appeared to meet the standards for meaningful, equitable participation [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e Our study established the feasibility of PV methodology with adolescents in India, when supported by researchers and with the permission and encouragement of their schools. Starting from a position of one expert (PC, based in the UK), we were able to cascade training to 17 researchers and lay counsellors in India and recruit four study schools and 56 adolescents to engage with PV on the topic of mental health in schools. None of our four main concerns were borne out. We did not encounter barriers associated with mental health stigma nor fears of school reputational damage if there are high levels of poor student mental health \u0026ndash; worries which can be widespread in India [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. The positive response to PV in our project may have been influenced by our use of the term \u0026lsquo;wellbeing\u0026rsquo; rather than \u0026lsquo;mental health\u0026rsquo;, by the relationship building undertaken by lay counsellors in schools, and by our constant commitment to work in partnership with schools who would retain editorial rights on any outputs [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]. We also did not see any evidence that PV was viewed only as a youth development activity, and we did not experience rejection or criticism of PV as a colonial practice imposing western values of adolescent voice and agency. The two schools hosting the final youth filmmaking crews gave permission for film screening to relatively large (albeit in house) groups, suggesting they saw PV to amplify the voices of young people rather than purely as a creative extra-curricular activity. Stakeholders at our impact event welcomed hearing youth perspectives in film form, highlighting the potential of youth voice via PV films to land well with decision-makers in India, a common phenomenon in the literature on PV [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Less clear, however, was the extent to which schools and stakeholders felt held to account by the films \u0026ndash; an issue raised by adolescent participants in [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. As PV in our project was at an early stage, we could not track the longer-term impact of the films on those audiences.\u003c/p\u003e \u003cp\u003eOur second research question enquired into whether PV met the standards for meaningful research participation with benefits for the adolescents. In line with much of the literature on PV [\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e] and resonating with the WHO\u0026rsquo;s global consensus statement on meaningful participation in research [\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e], PV was reported by our participants as an overwhelmingly positive experience that respected their skills, ideas, perspectives and strengths. Experiences were described as fun, exciting and interesting and some felt they had gained new skills and a new awareness of their competencies and creativity. Many reported stronger connections with peers, learning more about themselves and feeling enabled to address problems. Film screenings were reported to generate pride, challenging the view that talking about mental health is stigmatising for Indian young people.\u003c/p\u003e \u003cp\u003eEmpowerment is a widely celebrated outcome of PV with young people (e.g. 54, 55, 56, 57] but the concept is rarely defined nor measured. One exception is [\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e] PV project on tobacco control, where empowerment was defined as an individual\u0026rsquo;s beliefs about their capacity to influence others, including family, friends, community and the sociopolitical context, as well as their capacity to apply learning to their own health behaviours. Our data supports this. Adolescents reported pride at being able to share knowledge about lived experiences in schools, and many said they learned about mental health themselves. Their accounts also extended the concept of empowerment to being rendered visible and audible. The adolescents involved in the project valued the opportunity to \u0026lsquo;voice out\u0026rsquo; their opinions, felt good about \u0026lsquo;hearing my own voice\u0026rsquo; during the screenings and reported a sense of fulfilment at no longer being \u0026lsquo;anonymous\u0026rsquo; in their school community. Being included in this way may have been almost impossible in a face-to-face meeting with powerful professionals. Importantly, empowerment via PV in our project was an iterative process, which seemed to be carefully monitored and judged by the young people. This began with their assessment of the training process as truly equipping them to be creative leads, whether we really meant they had narrative freedom in the storyboarding stage and whether we would see through our commitment to screen \u0026lsquo;their voice\u0026rsquo;. Other PV studies have similarly reported that empowerment involves feeling trusted to have complete ownership over the process and final films, with an honest transfer of power from adults to them, without subterfuge [\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e, \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e]. [\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e] additionally argues that empowerment is supported, and recognised by young people, when adults facilitate groups of young people to come together and combine their power. Our study supports this hypothesis, with our adolescents reporting how much they valued working alongside peers.\u003c/p\u003e \u003cp\u003eWith regards to the helpfulness of PV as a methodology in school mental health intervention research, we identified multiple benefits following close audio-visual analyses of the films, focus groups about the PV experience, and film screening responses. Within the rigid power structures of the Indian school system, PV provided students freedom to inhabit the school space in a very different way to how they experienced it normally. The data suggested that PV gave adolescents an opportunity to build \u0026lsquo;psychological ownership\u0026rsquo; [\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e] of the intervention and in promoting it in their school community. PV helped the filmmakers, and those who saw the films, to understand the intervention more. Such \u0026lsquo;psychological ownership\u0026rsquo; can emerge when communities: get to know the intervention, for example, by experiencing it; invest themselves in it, for example, by contributing efforts; and by having some control over the intervention, for example, by being involved in decision-making. Although we did not anticipate this, adolescents in our study used and experienced PV as a tool to build such \u0026lsquo;psychological ownership\u0026rsquo;; this is a key finding, as ownership, or lack of it, can significantly influence an intervention\u0026rsquo;s acceptability and ultimately effectiveness [\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e] and may be one reason why, globally, school mental health interventions do not generally experience much success [\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e]\u0026ndash; students feel \u0026lsquo;done to\u0026rsquo; rather than \u0026lsquo;worked with\u0026rsquo;.\u003c/p\u003e \u003cp\u003eThe films also allowed us to see adolescents\u0026rsquo; perspectives on which intervention components were more or less important, which we could triangulate with post-intervention process evaluation data [\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e] to inform which intervention components could be dropped or intensified. For example, we were struck by the attention the lay counsellors attracted in the films. By seeing how adolescents were explaining the intervention to each other in the films, we could also see where there were misunderstandings, assumptions or false expectations, as well as what was working well, which we could respond to whilst the intervention was live. Such adaptive responses can support an intervention\u0026rsquo;s success [\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe use of PV in our study also helped us to understand adolescents\u0026rsquo; formulations of mental health and what responses they would like to see in their school. Notably, their formulations diverged from adult-centric, psycho-medical models of mental health which often situate poor adolescent mental health as a consequence of developmental changes, poor cognitive and emotional regulation, and engaging in risky behaviour [\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e, \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e]. While our intervention had been informed by the few available studies on Indian young people\u0026rsquo;s mental health [\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e] some insights and emphasises in the films were especially helpful to us. The films reminded us that school mental health interventions should be applied to everyday, typical situations affecting youth wellbeing and should contextualise poor mental health in terms of problems that happen to young people, rather than as an inevitable outcome of the adolescent stage per se. Films also emphasised to us that adolescents want to get to know a person (e.g. lay counsellor) before approaching them for help in school. They also underscored the importance of the young person being taken seriously. Furthermore, films indicated that interventions should equip adults to deliver \u0026lsquo;help that helps\u0026rsquo;. Particularly new to us was that interventions should support peer-led action for mental health, enabling adolescents to talk together about, and share strategies for, dominant concerns, especially bullying and managing academic stress. Such insights will be triangulated with our intervention logic models to include what young people see as mechanisms of change. The films also gave us, as researchers (many of whom were based in the UK), a sense of the implementation conditions [\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e] in schools from the perspectives of young people, which will enhance our interpretation and understanding of outcomes.\u003c/p\u003e \u003cp\u003eCritiquing PV\u003c/p\u003e \u003cp\u003eWhile our focus here has been to document the feasibility and helpfulness of PV as a participatory method in our school mental health research in India, we simultaneously raise critical issues around this method. First, we are not sure how inclusive our PV project was, where inclusion refers to involving a diverse range of young people, especially those who are usually excluded [\u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e]. This is a difficult criterion to evaluate. We did not collect demographic information about our youth filmmakers beyond school grade and gender. Although any young person could opt in to our PV project, it is possible that schools proffered their best students, or that only the most gregarious and creative young people opted in. As PV projects are limited in the number of filmmaking participants they can involve (due to the capacity of facilitators and/or the amount of equipment available), claims to broad inclusion will be difficult to substantiate. We have learned that we must find out more about who comes forward for PV projects in schools, and where greater effort is needed to support typically excluded young people.\u003c/p\u003e \u003cp\u003eSecond, PV is not in and of itself a liberating, participatory methodology. Rogers (2016), who used PV with young people in alternative education settings in Canada on the topic of violence, argues that PV projects in schools can never be fully shielded from the infiltration of power inequity and dominant, privileged discourses. He was particularly troubled by the individualistic and deficit discourses which emerged from adults\u0026rsquo; reflections on the PV project as \u0026lsquo;helping students better themselves\u0026rsquo;. In the films created in our projects, we were similarly troubled by the \u0026lsquo;back on track\u0026rsquo; idiom taken up by students in one film (Viona is Back on Track) and by a headteacher (in the SAMA documentary). Although both were referring to being \u0026lsquo;back on track\u0026rsquo; in academic work, the students\u0026rsquo; position was that they were sent \u0026lsquo;off track\u0026rsquo; by life circumstances whereas the headteacher attributed students going \u0026lsquo;off track\u0026rsquo; to being distracted, with low motivation and mobile phone addiction \u0026ndash; suggesting their need to be socially, morally and educationally reformed with an intervention like ours. The headteachers\u0026rsquo; blaming and perpetuation of \u0026lsquo;individualist and deficient discourses\u0026rsquo; in the documentary film was problematic to us, yet young people did not edit out the headteacher (who was expecting to see themselves in the film). We self-silenced to submit to the young people\u0026rsquo;s creative control here.\u003c/p\u003e \u003cp\u003ePerhaps such improvement discourse is inevitable when PV is conducted in schools but it nonetheless alerts us to the importance of the context in which PV projects are delivered, and how these are imbued with power that can talk over the marginalised voices which PV is meant to be championing. As further evidence of the presence of power, none of the films produced by our young people challenged, or held to account, the harsh and demanding Indian education system which has been linked to high levels of adolescent stress, anxiety, depression and suicide [\u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e, \u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e]. This neglect was curious to us, as we had anticipated films about the culture of academic demand and expectation. It may be that such films were not made as this system is not visible to young people or because it is not a system that they feel they can speak about or have potential to impact \u0026ndash; in which case, youth PV projects like ours may be inadvertently maintaining of oppressive structures. Of course, the lack of challenge about the oppressive education system may simply be due to the fact that the young people wanted to make films which showed their teachers more of their unseen problems, rather than to use PV as we had imagined (i.e. PV as an individual rather than political tool). This alerted us to how PV may be taken up by community filmmakers in ways that differ from the expectations of researchers.\u003c/p\u003e \u003cp\u003eThird, this then raised questions about how much we ought to have presented PV to the adolescents as a potential form of political and social justice action, in line with the method\u0026rsquo;s traditional purpose. This was dilemmatic for us, i.e. how creative freedom in youth PV projects can be balanced with steering them to exploit PV for social action. Rogers (2016) was left with similar questions. We concluded that the films made by our adolescents were indeed political in the sense that they challenged the individual deficit model of mental health and made calls for well trained, youth-centred relation-based support in schools. However, we have been left wondering if even more impactful films could have been produced had we framed the PV as political, although this may have been less palatable to recruited schools.\u003c/p\u003e \u003cp\u003eStrength and Limitations\u003c/p\u003e \u003cp\u003eA key strength of our study lay in the commitment to, and delivery of, equitable partnerships between the India-UK team, across our train-the-trainer model, and with schools and young people; indigenous knowledge, values and practices shaped project delivery. We conducted close audio-visual readings of the films. This is a reasonably unusual approach as PV research does not typically attend to the \u0026lsquo;types of film text such projects produce\u0026rsquo; and what these tell us about their producers\u0026rsquo; perspective [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. We secured much needed evidence about young people\u0026rsquo;s experience of this methodology, and showed how PV can be a novel and helpful method in a standard feasibility study design.\u003c/p\u003e \u003cp\u003eOur study was limited to four Indian secondary schools in one Indian state that had opted in to Project SAMA; they are likely to have been particularly supportive of youth participatory research and welcoming of youth voice. The project could only support a small number of film crews, and the benefits of PV as reported by them may not be experienced other Indian young people with differing needs or barriers to empowerment. Although project facilitators endeavoured to hand power to the youth film crews, their roles in the SAMA intervention are likely to have inherently shaped young people\u0026rsquo;s accounts of the intervention.\u003c/p\u003e"},{"header":"5 Conclusion","content":"\u003cp\u003e In the context of school mental health research, our study supports the use of PV as a meaningful participatory research practice with Indian young people. We advocate for its wider use to advance youth perspectives on how to address the significant unmet need in relation to adolescent mental health in India. We also advocate for the use of PV as a tool in intervention research, which can capture aspects of the intervention experience that are typically hidden or invisible to researchers. Notably, our study showed that PV may support psychological ownership of interventions and could be considered as an intervention mechanism. Critical reflection on the presence of power and dominant discourses should pervade all PV projects.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e: not applicable\u003c/p\u003e\n\u003ch3\u003eEthics approval and consent to participate\u003c/h3\u003e\n\u003cp\u003eEthical approval has been granted by the National Institute of Mental Health Neurosciences Research Ethics Committee (NIMHANS/26th IEC (Behv Sc Div/2020/2021)) and the University of Leeds School of Psychology Research Ethics Committee (PSYC-221).\u0026nbsp;This research was conducted in full accordance with the ethical principles outlined in the Declaration of Helsinki for research involving human subjects.\u0026nbsp;Informed consent to participate was obtained from all of the participants in the study and informed consent was obtained from the parents or legal guardians of participants below 16 years, prior to be included in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll participants and their legal guardians provided written consent for the publication of data, including anonymised quotes and film content. Where participants appeared on camera, explicit consent for public dissemination (e.g., on YouTube and during project events) was obtained.\u003c/p\u003e\n\u003ch3\u003eAvailability of data and materials\u003c/h3\u003e\n\u003cp\u003eAvailable from the corresponding author on reasonable request\u003c/p\u003e\n\u003ch3\u003eCompeting interests\u003c/h3\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003ch3\u003eFunding\u003c/h3\u003e\n\u003cp\u003eThis work was supported by the UK’s Medical Research Council, Economic and Social Research Council, National Institute of Health Research and UK Aid (Grant number MR/T040238/1). All views expressed here are of the authors only.\u003c/p\u003e\n\u003ch3\u003eAuthors’ contributions\u003c/h3\u003e\n\u003cp\u003eRN and SP: data collection, data analysis, writing - original draft; JN: supervision, writing-reviewing and editing; KH: writing-reviewing and editing; PC and SHJ: conceptualisation; data collection; data analysis; supervision; writing - original draft; writing-reviewing and editing. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003ch3\u003eAcknowledgements\u003c/h3\u003e\n\u003cp\u003eWe thank the schools and young people who participated in this study. We thank Jayalaxmi and Krupa and lay counsellors in schools for supporting the filmmaking process.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSchiavo R. What is true community engagement and why it matters (now more than ever). Journal of Communication in Healthcare [Internet]. 2021 Jul 19;14(2):91–2. 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Journal of Indian Association for Child and Adolescent Mental Health. 2014 Jan;10(1):47–68.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"discover-mental-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"dimh","sideBox":"Learn more about [Discover Mental Health](https://www.springer.com/44192)","snPcode":"","submissionUrl":"","title":"Discover Mental Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Adolescent, Public Mental Health, School, India, Participatory Video, Interventions","lastPublishedDoi":"10.21203/rs.3.rs-9384591/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9384591/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: Although Participatory Video (PV) is heralded as a powerful form of public participation in research, evidence about its ability to support equitable and inclusive research in low-and-middle income countries is lacking. Our study investigated the feasibility of PV as a tool to support evaluation of a community co-designed, whole school mental health program (Project SAMA) in Karnataka, India. Cultural perspectives around youth voice and stigma related to mental health in India presented uncertainties about the acceptability of PV in this context. \u0026nbsp;Our aim was to determine if PV was a feasible and helpful methodology for school mental health research in India and whether it benefits young people directly.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eThresholds for feasiblity and helpfulness were established. Following a train-the-trainer model, we delivered filmmaking workshops to adolescents in school (n=56, 12-16y) and they were invited to make films about their wellbeing in school and their experience of the SAMA program. Four films were created and screened in the filmmakers’ schools, at a stakeholder event and on the project's YouTube channel. Films were analysed via thematic analysis. Data was collected via audience feedback (n=56), focus group discussions with the filmmakers (n=31) and critical research team reflections.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eFour films were created and screened to n=286. Feasibility and helpfulness thresholds were met. Film analysis revealed participant perspectives on school wellbeing and the SAMA program not revealed in other forms of project evaluation. PV was found to benefit young people directly spanning skills development, confidence building and greater self-awareness. PV appeared to support school engagement and ownership of the program. However, power hierarchies and understanding of the political or advocacy potential of PV remain critical issues.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eOur student demonstrates the feasibility of PV to advance youth perspectives on adolescent and school mental health research in India. Our study showed that PV can support psychological ownership of interventions and could be considered as an intervention mechanism. PV for public mental health research should remain critically self-reflective and focus on generating evidence-based practice.\u003c/p\u003e","manuscriptTitle":"Rethinking the role of participatory video for school mental health interventions: insights from a feasibility study in Indian secondary schools","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-04 09:47:16","doi":"10.21203/rs.3.rs-9384591/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"218771941212136292278198375355777571828","date":"2026-05-16T11:30:24+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-12T14:33:21+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-07T08:53:39+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"271297453904606590089134381243311593054","date":"2026-04-29T07:18:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"26283574171729644748606133427638535579","date":"2026-04-22T19:33:00+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-22T12:35:22+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-04-20T09:47:44+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-16T11:51:58+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-16T11:50:34+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Mental Health","date":"2026-04-11T04:51:42+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-mental-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"dimh","sideBox":"Learn more about [Discover Mental Health](https://www.springer.com/44192)","snPcode":"","submissionUrl":"","title":"Discover Mental Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"35e75d2b-66cc-41f4-9ee0-b4755965da7e","owner":[],"postedDate":"May 4th, 2026","published":true,"recentEditorialEvents":[{"type":"reviewerAgreed","content":"218771941212136292278198375355777571828","date":"2026-05-16T11:30:24+00:00","index":103,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-12T14:33:21+00:00","index":91,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-07T08:53:39+00:00","index":90,"fulltext":""},{"type":"reviewerAgreed","content":"271297453904606590089134381243311593054","date":"2026-04-29T07:18:33+00:00","index":89,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-04T09:47:16+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-04 09:47:16","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9384591","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9384591","identity":"rs-9384591","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}