Topic guide for interviews with key stakeholders.

<div><p>People who have experienced trauma, especially adult survivors of childhood sexual abuse (CSA) are at risk of experiencing subsequent emotional and mental health difficulties. South Asian countries have high prevalence rates of CSA and other forms of complex trauma. Despite the requirement for mental health support for trauma survivors in South Asia, their needs are poorly understood, and specific interventions are still in their infancy. We aimed to explore the views of mental health professionals and key stakeholders on the mental health and support needs of trauma survivors, especially CSA survivors in South Asia and the treatment and support available. We interviewed mental health professionals and key stakeholders from six countries in South Asia who had experience working with trauma survivors. Data were analysed using reflexive thematic analysis. We interviewed 17 professionals and key stakeholders working in Afghanistan (n = 1), Bangladesh (n = 2), India (n = 8), Nepal (n = 2), Pakistan (n = 2) and Sri Lanka (n = 2). Four main themes were developed: mental health symptoms as the tip of the iceberg; a pragmatic approach to treatment and services; systemic factors are roadblocks to trauma services; cultural beliefs and practices across communities. We found that the participants view survivors’ difficulties as a combination of mental health problems and relationship difficulties, often dominating the mass of trauma. Despite systemic barriers, they extended their services to the survivors to make them as applicable as possible to the clients’ needs. For this, they considered the clients’ context. Overall, these professionals in South Asia acknowledged that the treatment and support that should be provided to trauma survivors, specifically adult CSA survivors, have not yet been formally established in South Asian contexts. Future research is needed to inform guidance for specific communities in the South Asian context.</p></div>