Background <p>Psychological First Aid (PFA) is globally recognised as an early intervention for psychological distress. However, existing frameworks are designed for disaster contexts and Western populations. Mental health challenges among Indian adolescents are intensifying, with rising depression, anxiety, suicidal behaviour, and conduct disorders. The limited contextual relevance of global PFA frameworks necessitates adaptation for Indian adolescents to achieve equitable access.</p> Methods <p>A qualitative study was conducted in Pune, Maharashtra, using semi-structured interviews with 16 mental health professionals, including psychiatrists, psychologists, and school counsellors. Professionals evaluated four PFA framework models, assessing their contextual relevance, mechanisms, limitations, and potential adaptations for Indian adolescents. The data were thematically analysed using MAXQDA 2022.</p> Results <p>Six essential components were identified for adaptation to an Indian adolescent-specific PFA framework: (1) consideration of safety, comfort, and rapport with adolescents; (2) stabilisation of adolescents, when required; (3) arrangements for reflective listening; (4) situational assessment of needs and challenges; (5) advice on coping information/options; and (6) referral services for supportive care and resources. PFA operationalisation requires cultural sensitivity, structured training, linguistic adaptation, destigmatization efforts, socioeconomic awareness, and integration with peer support networks.</p> Conclusions <p>These findings underscore the need for culturally relevant PFA framework models for Indian adolescents. This India-specific framework has potential applications in school delivery, workforce training, and policy alignment to help achieve equity and facilitate universal access.</p>