Understanding local perspectives on child mental health to strengthen school-based interventions in Darjeeling, India.

BackgroundChild mental health needs in low- and middle-income countries (LMICs) often go unmet due to a scarcity of specialists. In Darjeeling, West Bengal, India, Tealeaf (Teachers Leading the Frontlines), a task-shifting model in which teachers serve as lay counselors, has shown early promise. We explored stakeholders' culturally held beliefs about causes of child mental health concerns to contextualize Tealeaf's ongoing trial.MethodsWe conducted twelve semi-structured interviews (March-April 2022) with purposively selected principals, teachers, and caregivers. Using qualitative description, transcripts underwent deductive content analysis with codes mapped to the Culturally-Infused Engagement (CIE) model; analyses focused on perceived causes of child mental health concerns.ResultsParticipants attributed children's difficulties to biological factors and the home environment, noting that parenting guidance and peer influences could shape divergent outcomes across children. Younger children were perceived to experience stress and sadness related to academics. Stakeholders described children's emotional awareness and expressive ability as still developing, influencing expectations for classroom support.ConclusionsUnderstanding communities' culturally held beliefs is foundational to interpreting Tealeaf's effects and adapting school-based supports. Findings clarify contextual mechanisms and leverage points for a task-shifted system of care, informing how Tealeaf can engage sustainably with Darjeeling's cultural context and similar LMIC settings.