Naya Daur

1. Introduction

Version followed: Naya Daur as described by its operator, Iswar Sankalpa (Kolkata), on its programme page and in its Annual Report 2012–13, checked against its listing as a case study in the WHO 2021 Guidance and technical packages on community mental health services (Community outreach package, section 2.4) and against Ashoka, HUDCO, Hope Foundation and press profiles. The WHO case-study text itself could not be read in full (only its location and contributor list were reached) [uncertain].

What it is. Naya Daur ("new era") is not a psychotherapy. It is a city-wide, street-based community mental health outreach service for homeless people with psychosocial disabilities, started in June 2007 by Iswar Sankalpa, a Kolkata non-profit co-founded by Sarbani Das Roy (director, Ashoka Fellow) and psychiatrist Srikumar Mukherjee. It now covers 75+ municipal wards of North, South and Central Kolkata; the label "West Bengal" sometimes used for it refers to the state, but the programme is Kolkata-based. A multidisciplinary team (outreach social workers, a psychiatrist, counsellors, a restoration team) treats people where they live on the street and recruits neighbourhood residents (shopkeepers, tea and food vendors, police, municipal cleaners) as voluntary community caregivers who act as a "proxy family" [source: Iswar Sankalpa Naya Daur page; Annual Report 2012–13; NewsClick; Civil Society; WHO 2021 contributor list].

How change is thought to happen. Homeless people with psychosocial disabilities are excluded from hospital care partly because Indian admission typically requires a family name and address they cannot give, so care must go to them. Sustained, unhurried human contact by a neighbour, plus regular medication and basic needs, lets symptoms settle; as the person recovers, they recall identity and family, take on small work, and either return home ("restoration") or are resettled locally as citizens with documents and income. In parallel, turning people who already encounter them (police, vendors, cleaners) "from perpetrators to care providers" reduces stigma in the neighbourhood [source: Naya Daur page; Ashoka Fellow profile; Annual Report 2012–13].

Who this guide is for. A clinician (psychiatrist, psychologist, psychotherapist, psychiatric social worker) joining or partnering with Naya Daur, or adapting a street-based proxy-family model elsewhere. No certification, licence or fidelity scale for delivering "Naya Daur" was found; it is an organisational programme, not a franchised model. Anyone wishing to use the name or replicate formally should contact Iswar Sankalpa [uncertain: no published replication manual found].

2. Framework

Iswar Sankalpa does not publish numbered phases with session counts. The stages below are assembled from the order in which its annual report, programme page and profiles describe the work; the stage labels and transition criteria are [synthesis] unless tagged.

Duration. Open-ended. Published cases run from about two years of street treatment before a person recalls their hometown to roughly 12 years before a family was traced [source: Annual Report 2012–13; Naya Daur page]. Many never return home: Civil Society reported 30–40% of shelter residents remain because recall or family acceptance is lacking.

Follow-up status categories the programme uses in reporting: under follow-up, gone missing, discontinued, irregular [source: Annual Report 2012–13]. These are a practical way to review a caseload.

Related Iswar Sankalpa services Naya Daur feeds into [source: Annual Report 2012–13; Civil Society; HUDCO]:

• Two day-care centres: inside Hastings Police Station (since 2009, space provided by Kolkata Police) and in the Keoratala community.
• Sarbari: 24x7 shelter and rehabilitation centre for homeless women with psychosocial disabilities (since April 2010, with Kolkata Municipal Corporation); Marudyan for men.
• Arogya emergency response unit (with Kolkata Police and state psychiatric and general hospitals).
• Restoration and vocational programmes; the Urban Mental Health Programme integrating mental health into KMC ward health units for slum populations.

3. Guiding principles

None of the sources lists formal principles. These are drawn from the stated aims and practices; each is tagged.

• Treat people where they are. Care is delivered "in the very place on the streets" rather than waiting for hospital admission. In practice: go to the person's pavement, station or market spot; do not make engagement conditional on coming to a clinic [source: Naya Daur page].
• Relationship first. Rapport is described as the first step. In practice: early visits are for conversation and needs, not assessment forms [source: NewsClick, Das Roy quote].
• Anyone with empathy can be a caregiver. In practice: recruit the neighbour already feeding the person before looking for professionals [source: Ashoka Fellow profile].
• Community as resource; minimal inputs. In practice: the professional team supports and supervises a natural helper rather than replacing them [source: Ashoka story].
• Citizenship and identity. The goal is for clients to reclaim their place as citizens. In practice: work on names, documents, bank accounts and entitlements is clinical work, not an add-on [source: Naya Daur page; Annual Report 2012–13].
• Dignity and rights. Shelter users are "residents, not inmates"; WHO lists the programme as rights-based community mental health. In practice: use respectful language, involve people in choices about activities, avoid institutional framing [source: Civil Society; give.do profile; WHO 2021 listing].
• Consent for step-up care. Women enter Sarbari only if they agree; a "modicum of consent" is needed for shelter admission. In practice: offer, explain and wait; force is not the default route [source: Annual Report 2012–13; Civil Society]. Police are called if someone becomes violent [source: Civil Society], so this principle has limits [uncertain how these are balanced in current practice].
• Non-institutional recovery. The model aims to help people recover "right where he belonged" without hospitalisation where possible. In practice: hospital is for acute need, not a destination [source: Civil Society].
• Turn bystanders into carers. Police lock-ups and vendor stalls become safe spaces. In practice: sensitise and enlist police, cleaners and vendors rather than seeing them only as risks [source: Ashoka Fellow profile].
• Protection from harm on the street. Homeless people with psychosocial disabilities face road accidents, sexual abuse, unwanted pregnancy, malnutrition and physical illness. In practice: screen for and act on these at every contact, especially for women [source: Naya Daur page; HUDCO].
• Networked care. Government, private and community resources are linked. In practice: your job includes coordinating with KMC health units, police, hospitals and other NGOs [source: Annual Report 2012–13].
• Patience over time limits. In practice: no discharge for slow progress; keep visiting [synthesis, consistent with multi-year cases in sources].

4. Intervention inventory

The sources name each component below but rarely give step-level procedure. In each entry, what is done and who does it are sourced; the numbered steps are written as a workable procedure and are [synthesis] unless a step carries its own source tag. All example language is illustrative and would be spoken in Bengali or Hindi in Kolkata.

4.1 Street identification rounds

• Purpose / when: Find homeless people with probable psychosocial disability and keep track of known clients. Ongoing, daily [source: Annual Report 2012–13].
• Steps:
  1. Social workers walk assigned wards daily, checking new and existing clients in the same round [source: Annual Report 2012–13].
  2. Look especially at transit points where people end up after leaving home or being abandoned: railway stations, bus depots [source: NewsClick].
  3. Take referrals from police, neighbours and local vendors, and from medical or awareness camps (one client was first met at a camp) [source: Annual Report 2012–13; Hope Foundation].
  4. Note the person's usual spot, times present, visible health problems, who already feeds or tolerates them, and immediate dangers (traffic, injury, pregnancy, exposure) [synthesis].
  5. Record on a register so drift can be detected [synthesis; the programme reports a "gone missing" category].
• Example language (illustrative), to a shopkeeper: "We are from Iswar Sankalpa. We help people living on the street who seem unwell. Has she been here long? Does anyone give her food?"
• Watch for: Mistaking poverty, substance use, dementia, intellectual disability or physical illness for psychosis; acute medical emergencies (go straight to 4.10). Working: a growing list of located, regularly seen people [synthesis].

4.2 Rapport building on the street

• Purpose / when: Make contact tolerable and trusted before any treatment. Always the first step; may take a long time [source: NewsClick, quoting Das Roy and caregiver Swapan Saha].
• Steps:
  1. Approach calmly, at the person's level, without crowding; introduce yourself by name each time [synthesis].
  2. Talk first; offer food, water, tea or hygiene items as a gesture, not a bargain [source: Annual Report 2012–13 lists food and hygiene provisions; ordering is synthesis].
  3. Return at a predictable time and place; brief repeated contacts are fine [synthesis].
  4. Ask about preferences and what they need today; accept refusals and leave politely [synthesis].
  5. Only after several tolerated contacts, ask whether a doctor may come and talk [synthesis].
• Example language (illustrative): "I'm Rina. I come by this corner most mornings. Would you like some tea? You don't have to talk." / "Is there anything bothering you today, pain, cold, people troubling you?"
• Watch for: Fear, paranoid interpretation of help, gender safety (a woman client may accept a woman worker first) [synthesis]. Working: the person recognises you, waits for you, accepts items, starts to talk [synthesis].

4.3 Street-based psychiatric assessment and treatment

• Purpose / when: Diagnose and start treatment without requiring admission, once the person tolerates contact. The programme's psychiatrist diagnoses clients and advises on referrals (e.g. day care for someone with paranoid schizophrenia); doctors visit clients on the street [source: Annual Report 2012–13; Civil Society].
• Steps:
  1. Social worker briefs the psychiatrist on history gathered in 4.1–4.2 and accompanies them, so the face is familiar [synthesis].
  2. Assess on the spot: mental state, risk, cognition, substance use, physical health, pregnancy; screen for injuries and infections [synthesis; the programme notes high rates of physical ailments in rescued women per HUDCO].
  3. Explain what medicine is for in plain terms and seek agreement [synthesis].
  4. Prescribe; the programme supplies psychotropics and has worked to make supply steady because interruptions harm adherence [source: Annual Report 2012–13]. (No dosing here.)
  5. Decide who will hand the medicine over day to day (4.4) and how follow-up will happen [synthesis].
  6. Refer for physical illness to doctors or government hospitals as needed; Hope Foundation reports clients treated in government hospitals [source: Hope Foundation].
• Example language (illustrative): "This doctor works with us. She'd like to ask how you've been sleeping and whether the voices trouble you. There's a tablet that helps many people feel calmer; would you try it?"
• Watch for: Side effects in malnourished or medically ill people, interactions with untreated physical illness, pregnancy, sedation that increases street risk [synthesis]. Working: calmer behaviour, better self-care, longer coherent conversations; one client was described as improving with medication [source: NewsClick].
• Telehealth variant: During COVID-19 lockdowns doctors' physical visits shifted towards virtual check-ups [source: NewsClick].

4.4 Mobilising community caregivers ("proxy family")

• Purpose / when: Provide daily continuity, food, medicine and human contact through a neighbour. The programme's core mechanism; set up as soon as a willing person is found. A programme officer described it as social workers building "a proxy family for their clients" [source: NewsClick].
• Who: Grocers, tea-stall owners, food and roadside vendors, residents, police, municipal cleaners [source: NewsClick; Ashoka Fellow profile; Ashoka story; Naya Daur page]. Caregivers are voluntary; numbers have ranged from about 80 to 190 per year [source: Civil Society; give.do; Hope Foundation].
• Steps:
  1. Identify who already has a relationship with the person (feeds them, lets them sit near the shop) [synthesis, consistent with case examples].
  2. Explain the programme and ask if they would help with a defined task: give medicine at a set time, give a meal or drink, encourage bathing, notice changes [source for task types: NewsClick].
  3. Agree the routine concretely (which tablet, when, what to do if refused) and give the caregiver a contact number [synthesis].
  4. Social worker visits both client and caregiver regularly to check progress and supply medicine [source: NewsClick, Annual Report 2012–13].
  5. Support the caregiver: acknowledge their effort, help with problems; during COVID the organisation gave caregivers relief materials, as many are themselves poor [source: NewsClick].
  6. Where possible spread responsibility across several people or a group, not one individual [source: Annual Report 2012–13 notes this trend].
• Example language (illustrative), to a vendor: "You already give him tea every night. Would you also give him this one tablet with it? We'll bring the strip each week and I'll call in every few days."
• Watch for: Caregiver burnout, financial strain, exploitation (unpaid labour by the client), coercive medication, neighbour hostility [synthesis; NewsClick records shopkeepers objecting at first]. No published caregiver selection, training or safeguarding protocol was found [uncertain]. Working: regular medicine intake, the caregiver reports improvement, neighbours' attitudes soften [source: NewsClick].

4.5 Medication supervision and supply

• Purpose / when: Keep treatment continuous for people with no storage, routine or money.
• Steps:
  1. Social worker holds stock and delivers small quantities to the caregiver [synthesis; supply role sourced: Annual Report 2012–13].
  2. Caregiver hands over doses at an agreed time; flexibility exists, e.g. a vendor gave the dose to the client's father when the client was away [source: NewsClick]. A local ironing-man supervised one man's medication [source: Civil Society].
  3. Social worker checks remaining tablets, side effects and missed days at each visit [synthesis].
  4. Report problems to the psychiatrist; adjust plan [synthesis].
• Example language (illustrative), to client: "Didi will keep your tablets safe and give you one with dinner. If they make you feel bad, tell her or me."
• Watch for: Stock-outs (a named programme challenge), hoarding or selling of medicine, covert administration (do not do this without proper legal and ethical basis) [source: Annual Report 2012–13 for stock-outs; rest synthesis].

4.6 Basic needs and physical health care

• Purpose / when: Survival and dignity; also a vehicle for engagement. Every contact.
• Steps: Food distribution, hygiene provisions, doctor visits for physical health (the 2012–13 report counts all three); encourage bathing; refer to hospital for injuries and illness [source: Annual Report 2012–13; NewsClick].
• Example language (illustrative): "That cut on your foot looks sore. Can I clean it, or shall I bring the doctor tomorrow?"
• Watch for: Malnutrition, injuries, sexual violence, pregnancy, HIV and other infections, especially in women [source: HUDCO; Naya Daur page].

4.7 Psychosocial and counselling support

• Purpose / when: Support recovery, explore interests, build skills, once symptoms ease. Counsellors and therapists provide psychotherapy and identify client interests; counselling and medical aid are counted together in outcome reports [source: Annual Report 2012–13; Hope Foundation]. No specific psychotherapy model is named [uncertain].
• Steps (clinician's role) [synthesis]:
  1. Use brief, supportive, problem-focused conversations on the street or at day care.
  2. Gently explore personal history, names, places, languages, as recall returns; this feeds restoration (4.11).
  3. Identify interests and abilities for occupation (4.12).
  4. Address trauma carefully; prioritise safety and stabilisation over detailed disclosure.
• Example language (illustrative): "You mentioned a river near your village. Do you remember its name, or the market nearby?"
• Watch for: Distress when memories return; family rejection stories; grief over lost years [synthesis].

4.8 Therapeutic day care

• Purpose / when: Structured daytime therapeutic setting for clients who are ready for more activity but still homeless; the psychiatrist may recommend it [source: Annual Report 2012–13].
• Sites: Dr K. L. Narayanan Rehabilitation Centre inside Hastings Police Station (since 2009) and a centre in Keoratala [source: Annual Report 2012–13; Naya Daur page].
• Content: Cooking, dance movement therapy, art therapy, gardening, detergent making; regular doctor and counsellor visits supporting medication and psychotherapy; aims at physical, emotional and social recovery; reported gains in self-care, social and vocational skills [source: Annual Report 2012–13].
• Steps [synthesis]: invite (do not require); escort on first visits; start with short stays; let the client choose activities; review progress with the psychiatrist.
• Example language (illustrative): "There's a place nearby where people cook and paint together in the day. Would you like to come and just look?"
• Watch for: Fear of a police-station setting; low attendance (the report notes modest numbers). Working: regular voluntary attendance; one man began attending after a couple of years and recovery followed [source: Civil Society].

4.9 Referral to shelter (Sarbari, Marudyan)

• Purpose / when: Round-the-clock care when street life is unsafe or illness is severe, e.g. acute schizophrenia, or for women at high risk of abuse [source: Civil Society; Annual Report 2012–13].
• Steps:
  1. Referral comes via Naya Daur outreach or Kolkata Police; the woman must agree to come [source: Annual Report 2012–13].
  2. Early phase: hygiene, physical and mental health care, symptom reduction [source: Annual Report 2012–13].
  3. Daily life: household tasks as life-skills therapy; residents involved in choosing activities [source: Annual Report 2012–13; Civil Society].
  4. Vocational phase: counsellors identify interests, then occupational and vocational training (stitching, cooking, decoupage, art; a café and bakery) [source: Annual Report 2012–13; Civil Society; BGES page].
  5. Exit: restoration to family or resettlement in the community [source: Annual Report 2012–13].
• Capacity: Sarbari about 80 women; Marudyan about 30 men [source: Annual Report 2012–13; Civil Society].
• Example language (illustrative): "There is a women's home where you'd have your own bed, meals and a doctor. You can visit first and decide. Nobody will lock you in a ward."
• Watch for: Distress from high turnover of co-residents; elderly or untraceable women with nowhere to go; shelter not equipped for geriatric care [source: Annual Report 2012–13]. Note: the sleeping area is locked by day to protect night sleep [source: Civil Society]; explain this rule honestly.

4.10 Emergency response (Arogya unit)

• Purpose / when: Urgent care for people in acute psychiatric or medical distress found during outreach or by police [source: Annual Report 2012–13].
• Steps:
  1. Medical crisis response team assesses the person [source: Annual Report 2012–13].
  2. Coordinate with health and legal bodies (police, state psychiatric and general hospitals) for custody and care [source: Annual Report 2012–13].
  3. Arrange immediate hospitalisation or relief as needed [source: Annual Report 2012–13].
  4. After the crisis: return to street care with a caregiver, shelter, restoration, or referral to another NGO [source: outcomes listed in Annual Report 2012–13].
• Clinician tasks [synthesis]: standard risk assessment (suicide, self-harm, violence, self-neglect, medical instability); least restrictive option; use current Indian mental health law for any involuntary step (the Mental Healthcare Act 2017 has provisions on homeless persons) [uncertain]; document capacity and the person's expressed wishes.
• Example language (illustrative): "You're very unwell and I'm worried you're hurt. I'd like to take you to the hospital now, and I'll come with you."
• Watch for: Deaths occur in this group (the report lists deaths among outcomes); police training gaps [source: Annual Report 2012–13].

4.11 Restoration (family tracing and reunification)

• Purpose / when: Return people to families who will receive them, once recall returns and the person wants it [source: Annual Report 2012–13; Naya Daur page].
• Steps:
  1. As the person recovers, collect fragments: name, village, district, language, landmarks, occupation (one man recalled he had been an X-ray technician) [source: Naya Daur page; Annual Report 2012–13].
  2. Restoration team traces the family through police stations, Panchayats and other agencies [source: Annual Report 2012–13].
  3. Verify identity and family relationship [source: Annual Report 2012–13]; where someone is in a vagrancy home, verify with the Controller of Vagrancy before release (case example) [source: Annual Report 2012–13].
  4. Arrange family visit, reunion and repatriation [source: Annual Report 2012–13].
  5. Link the person to the local health centre at home so treatment continues; follow up after restoration [source: Annual Report 2012–13].
  6. Counsel the family about the illness and medication [synthesis].
• Example language (illustrative): "We think we've found your brother in Nagpur. Would you like to speak to him on the phone first?"
• Watch for: Clients from almost every Indian state; language barriers; obscure places; rejection by family or village; medication lapse after return due to cost or access; re-restoration cases [source: Annual Report 2012–13]. Check whether the client actually wants to go and whether the home is safe (abuse may be why they left) [synthesis].

4.12 Livelihood, occupation and resettlement

• Purpose / when: Restore role, income and self-sufficiency, and offer a future for those who cannot go home [source: Annual Report 2012–13; Civil Society].
• Steps:
  1. Start with small, informal work, often for the caregiver (the grocer who later employed his client; a sweet-shop owner who offered a job) [source: Naya Daur page; Civil Society].
  2. Vocational and occupational training, functional literacy, supportive employment [source: Annual Report 2012–13].
  3. Resettlement in community living or work with accommodation (e.g. one woman resettled as a live-in domestic worker who still attends health follow-ups) [source: Annual Report 2012–13].
• Example language (illustrative): "You've been helping at the shop. Would you like to learn tailoring too?"
• Watch for: Exploitative or unpaid work; work outrunning recovery [synthesis]. Working: earnings (one client buys his own phone), staying housed most days [source: NewsClick].

4.13 Identity documents and entitlements

• Purpose / when: Legal identity is a precondition for hospitals, benefits and citizenship; begin once a stable address of contact exists [source: Naya Daur page].
• Steps: Help obtain disability certificates, bank accounts and Aadhaar (UID) cards [source: Annual Report 2012–13]; the programme reports "entitlement support" as an outcome [source: Naya Daur page]. Ration cards for homeless women have been reported (a Paul Hamlyn Foundation item) [uncertain].
• Example language (illustrative): "With this card you can get rations and treatment at government hospitals. Shall we apply together?"
• Watch for: Documents held by others, loss or theft on the street [synthesis].

4.14 Community awareness and neighbourhood committees

• Purpose / when: Reduce stigma, find new clients and caregivers, ease reintegration. Continuous.
• Steps: Awareness camps (the 2012–13 report records 24; Hope reports 28 with 715 attendees) aimed at reducing stigma, identifying clients and caregivers, and sensitising stakeholders; informing Panchayats, community officers, NGOs and neighbours [source: Annual Report 2012–13; Hope Foundation]. Local influencers (municipal officers, teachers, small-business owners) bring people to health centres and form neighbourhood committees that resolve family issues, e.g. persuading a family to accept a relative back; committees have run door-to-door sensitisation [source: Ashoka Fellow profile].
• Example language (illustrative), at a camp: "Many people on our streets have an illness that can be treated. Feeding someone and passing on a tablet can change their life."
• Watch for: Slurs for mental illness common locally (shelters called "pagaler ghar") [source: Civil Society]; correct gently.

4.15 Police and municipal engagement

• Purpose / when: Convert enforcement contacts into care and protect clients from harmful removals.
• Steps:
  1. Partnerships: police provide a day-care space in Hastings Police Station; police hand over rescued people; Arogya works with police stations [source: Annual Report 2012–13; Civil Society].
  2. Advocacy: after clients were taken in raids to vagrancy homes without proper care, the team approached the Vagrancy Department and Deputy Mayor's office asking for advance notice of raids [source: Annual Report 2012–13].
  3. Sensitisation: lock-ups become safe spaces; police have run sessions for schoolchildren on recognising and helping homeless people with mental illness [source: Ashoka Fellow profile].
• Clinician tasks [synthesis]: maintain a named liaison at each station; share (with consent) who is a client; give police a number to call before removing a client.

4.16 Linking with primary care (Urban Mental Health Programme)

• Purpose / when: Sustainable treatment in KMC ward health units for slum populations and people after recovery [source: Annual Report 2012–13; Ashoka Fellow profile].
• Steps: Train KMC medical officers and health workers for early identification and treatment (10 doctors and 53 health workers trained in 2012–13); psychiatrist visits weekly, then fortnightly, for severe cases; psychotropics supplied by KMC through the health unit; counselling, rehabilitation support and support groups; planned Ward Mental Health Committee for monitoring and grievances [source: Annual Report 2012–13; Ashoka Fellow profile].
• Watch for: Engaging ward health staff consistently; low community awareness [source: Annual Report 2012–13].

4.17 Caseload review and tracing missing clients

• Purpose / when: Homeless clients drift, interrupting treatment; review regularly.
• Steps: Classify each client as under follow-up, irregular, discontinued or gone missing [source: Annual Report 2012–13]. For missing clients, ask caregivers and vendors, check police stations, hospitals and vagrancy homes (one missing client was found in a vagrancy home and then reunited) [source: Annual Report 2012–13; checking routine is synthesis].
• Example language (illustrative), to a caregiver: "When did you last see him? Did anyone say where he went?"

5. Handling problems

Sourced problems are tagged; responses not described by Iswar Sankalpa are [synthesis].

• Person refuses contact or is frightened. Rapport took "a lot of time" for caregivers [source: NewsClick]; one man took a couple of years to start attending day care [source: Civil Society]. Response: keep short, predictable visits with food or tea and no demands; use a familiar neighbour as go-between; match worker gender to the client where possible; never make food conditional on accepting treatment [synthesis].
• Refuses medication (non-adherence). Response: explore what they dislike (side effects, beliefs, fear of poisoning); let the psychiatrist simplify the regimen; route doses through the person they trust most; accept partial engagement and keep meeting basic needs; record capacity and wishes; never use covert medication without a lawful, documented basis [synthesis].
• Medicine stock-outs. A named programme problem [source: Annual Report 2012–13]. Response: keep a buffer stock, link clients to KMC health units that supply psychotropics [source: Annual Report 2012–13 for KMC supply], and warn caregivers early [synthesis].
• Client goes missing (drift). A named problem; one client was found in a vagrancy home after a raid [source: Annual Report 2012–13]. Response: as 4.17; ask police for advance notice of raids [source: Annual Report 2012–13]; give clients an ID card or contact slip if they agree [synthesis].
• Caregiver burnout, poverty or withdrawal. COVID strained caregivers financially and reversed progress [source: NewsClick]. Response: regular check-ins with caregivers, practical relief, sharing tasks across several neighbours or a group [source: NewsClick; Annual Report 2012–13]; thank caregivers publicly with consent; have a backup plan for each client [synthesis].
• Caregiver overstepping (coercion, exploitation, abuse). Not addressed in sources [uncertain]. Response: agree tasks clearly; check privately with the client; watch for unpaid labour, withheld food, sexual exploitation; if abuse is suspected, end the arrangement and follow safeguarding and police reporting routes [synthesis].
• Neighbour hostility and stigma. Shopkeepers objected to a "mad" person nearby [source: NewsClick]; local slurs [source: Civil Society]. Response: awareness events, involve local influencers and committees [source: Ashoka Fellow profile]; meet objectors in person and show progress [synthesis].
• Acute crisis, violence or medical emergency. Police are called if a person becomes violent [source: Civil Society]; Arogya coordinates hospital care [source: Annual Report 2012–13]. Response: least restrictive option, accompany the person, explain what happens next, follow Indian mental health law for any involuntary step [synthesis; law not drawn on, uncertain].
• Suicide or self-harm risk. Not addressed in sources. Response: standard risk assessment (current thoughts, plans, prior attempts, intoxication, hopelessness, protective factors); safety planning adapted to the street (who the person can go to, where the caregiver is); lethal-means counselling about access and safe storage of medicines, which caregivers can hold in small quantities [synthesis].
• Women's safety, sexual violence and pregnancy. Documented high risk [source: HUDCO; Naya Daur page]. Response: prioritise shelter offer (Sarbari), women workers, medical and forensic care if assaulted, antenatal referral, consent-focused discussion of options [synthesis for specifics].
• Overwhelm when memories return or family rejects. Families and villages often reject returning clients; re-restorations happen [source: Annual Report 2012–13]. Response: pace disclosure; prepare the client for possible rejection; family counselling before reunion; keep a resettlement option open; follow up after return [synthesis; follow-up sourced].
• Unwanted restoration. Not addressed in sources. Response: restoration is an offer, not a target; check why the person left home (violence, abuse, dowry disputes) and respect a choice to stay [synthesis].
• Rupture with the team (e.g. after police involvement or hospital admission). Not addressed. Response: go back to the spot, name what happened, apologise for what felt forced, return to basic-needs contact [synthesis].
• Elderly or untraceable clients with no exit. 30–40% of shelter residents stay long-term; geriatric needs exceed shelter capacity [source: Civil Society; Annual Report 2012–13]. Response: plan for long-stay supported living and community resettlement rather than repeated restoration attempts [source: report notes plans for a long-stay home; rest synthesis].
• Continuity after restoration. Cost and access disrupt medication at home [source: Annual Report 2012–13]. Response: link to the local health centre before departure, send a written summary, phone follow-up [source for linkage; rest synthesis].
• Clinician boundary issues. Working on the street blurs roles. Response: no personal money or gifts beyond programme provisions, work in pairs at night or in isolated places, supervision for the team [synthesis].

Sources

Sources:

• Naya Daur – Iswar Sankalpa programme page
• Iswar Sankalpa Annual Report 2012–13 (PDF)
• Ashoka Fellow profile: Sarbani Das Roy
• Ashoka: Community of Care – the Ashoka Fellow bringing mental healthcare to Kolkata's homeless
• Civil Society: A home and inner peace for those on the street
• NewsClick: Messiahs take care of homeless persons with mental illness
• HUDCO Best Practice Awards, page 74 (Iswar Sankalpa)
• Give.do: Iswar Sankalpa profile
• Hope Foundation: Naya Daur
• BGES: Reaching out to the forgotten
• WHO (2021) Guidance on community mental health services (medbox copy): only contents and contributor list read; Naya Daur section 2.5.4 [uncertain]
• WHO (2021) Community outreach mental health services technical package (medbox copy): section 2.4 (Naya Daur) not reachable in the extracted text [uncertain]
• WHO executive summary page

Further reading (not drawn on): Iswar Sankalpa home page; Paul Hamlyn Foundation item on ration cards for homeless women; the Mental Healthcare Act 2017.

Books and reports cited: World Health Organization (2021). Community outreach mental health services: promoting person-centred and rights-based approaches. Geneva: WHO (case study 2.4, Naya Daur, not read in full).