Institutional Mapping Report Final by Keystoneinstituteindia

Table of Contents The Women Welfare and Rehabilitation Centres at Kedarpuram, Kotdwar, Pithoragarh, Haldwani, and Almora

The Women Welfare and Rehabilitation Centre at Kedarpuram, Dehradun

The Women Welfare and Rehabilitation Centre at Kotdwar

The Women Welfare and Rehabilitation Centre at Pithoragarh

The Women Welfare and Rehabilitation Centre at Haldwani

The Women Welfare and Rehabilitation Centre at Almora

So, What does all this Mean?

Final Words

References

Institutional Mapping Report: The Women Welfare and Rehabilitation Centres at Kedarpuram, Kotdwar, Pithoragarh, Haldwani, and Almora

Institutional Mapping Report

The Women Welfare and Rehabilitation Centres at Kedarpuram, Kotdwar, Pithoragarh, Haldwani, and Almora Collaborators Department of Women Welfare, Government of Uttarakhand Keystone Institute India Rural India Supporting Trust Kedarpuram Women Welfare Rehabilitation Centre Staff and Leadership Kotdwar Women Welfare Rehabilitation Centre Staff and Leadership Pithoragarh Women Welfare Rehabilitation Centre Staff and Leadership Haldwani Women Welfare Rehabilitation Centre Staff and Leadership Almora Women Welfare Rehabilitation Centre Staff and Leadership Herbertpur Christian Hospital Major Contributors

Rishab Kumar Anand Prashansa Pandey Shalini Bisht S Ramananthan Rachit Pandey Chesta Pandey Geeta Mondol

Analysis and Report Authors

Elizabeth Neuville Mohammad Imran Ali, PhD

Institutional Mapping Report: The Women Welfare and Rehabilitation Centres at Kedarpuram, Kotdwar, Pithoragarh, Haldwani, and Almora

Overview Keystone Institute India and our partners, the Rural India Supporting Trust, and The Hans Foundation, have worked in unison with the Government of Uttarakhand to develop community-based supportive services as an alternative to custodial institutions. The Department of Women’s Welfare has been supportive over the course of leadership changes, and we are fortunate to have such an excellent government partner willing to explore options. To date, we have focused on the establishment of small community residences (Community Lives in Herbertpur) and a focused Family Reunification program (Unity Uttarakhand) for formerly institutionalised persons at the Nari Niketan in Dehradun. We are currently developing Supported Living and Family Living Pilot Models to expand the options for women living in the Nari Niketans of Uttarakhand. Along with our partners, we are committed to modelling deinstitutionalisation at the 5 custodial care institutions in Uttarakhand, with an eye to creating effective exit pathways as well as limiting entrance pathways to avoid institutionalisation in the first place.

Understanding India’s Custodial Care Institutions As is well defined within the UNCRPD as well as the Mental Health Act of 2017 and the RPD Act of 2016, people with disability should be considered as fully deserving of the rights and freedoms experienced by all Indian citizens. This sets the expectations that people with disabilities should be able to have the accommodations as necessary to live in the community, work, and experience all the benefits and rights expected from life in the community. And yet, we know that across the world, and also in India, people with disabilities including physical, sensory, developmental and psychosocial disabilities are routinely sent to highly segregated facilities, in which they are isolated from society, work, education, and relationships. Government custodial facilities exist across the country, often run by the state in which they are located, as a last-resort place for people to stay. Loosely defined, institutions for people with disabilities can be seen as facilities where such people are:

congregated in groups

segregated from typical people and places in the community

subjected to routines and schedules which are highly regimented

granted limited access to acquire or store one’s own personal possessions

Since the earliest Indian institutions, rooted in the establishment of asylums by the British East India Company as early as 1700’s, the separation of Indian citizens into such places has been the cause of great suffering. We are indebted to the cross-India partnership engaged to complete the National Strategy for Inclusive and Community-Based Living for Persons with Mental Health Issues (2019), with important findings as to the composition of India’s long-stay institutions, as well as ways forward towards community-based alternatives.

Institutional Mapping Report: The Women Welfare and Rehabilitation Centres at Kedarpuram, Kotdwar, Pithoragarh, Haldwani, and Almora

According to Open Society Foundations “Residents of institutions have no privacy or personal space, must live with people they have not chosen and may not like, and cannot pursue personal interests or relationships. An institution is not defined by size: even smallscale facilities can perpetuate these conditions.”

This report, commissioned by the Government of India with The Hans Foundation in the lead, gives us an essential big-picture view of India’s 42 state-run Psychiatric Mental Hospitals. Our debt and appreciation extend to Human Rights Watch 2015 article Girls with Psychosocial or Intellectual Disabilities in India detailing the plight of women and girls in long-stay institutions, including institutions for people with developmental disabilities and government shelter homes, not included in the 2019 study, which helps to fill in the gaps. Across India, both cities and states operate institutions directed primarily to serve people with intellectual and developmental disabilities, as well as other disabilities. These institutions have not been fully included in the national plan for deinstitutionalization, and this effort to localize the way forward by focusing on shelter homes in one small and progressive state can offer valuable insight in planning efforts to both reduce the number of institutionalised persons and assisting those who are already in such places to be supported in community toward regular lives of citizenship, valued roles, and participation. Nari Niketan Kedarpuram, Dehradun is one such facility specifically created to house people with developmental and psychosocial disabilities. This is a facility which has received a high degree of negative attention over the past years and has had many upgradations to the physical site. Still women living there have little hope of leaving. Many have families who are lost to them, and Family Reunification is one of the only exit paths. In 2019, two small community homes were launched, and nine women, in all, were able to leave the institution over the course of the next two years. One of these women died due to natural causes in 2020, leaving the number of total liberated women to eight. In 2021, a well-supported family reunification program was initiated through a public/ private partnership between the Government of Uttarakhand, Keystone Human Services International, Rural India Supporting Trust and The Hans Foundation to make provisions for finding people’s families and reuniting them, where possible. Thus far, over 20 reunifications have been made in the first 18 months, including for people who have come from other countries and states, and all reunified with significant follow-up over the first few months. It is the aim of both Keystone and our partner, the Rural India Supporting Trust, to assist people interred at long-stay custodial institutions such as this one to live a more integrated life in community settings. This interest is shared by the government of Uttarakhand, which has consistently supported such efforts. This is because of the knowledge of the positive outcomes and enormous benefits when institutionalised people with disabilities

Institutional Mapping Report: The Women Welfare and Rehabilitation Centres at Kedarpuram, Kotdwar, Pithoragarh, Haldwani, and Almora

are supported to establish lives in the community. In fact, such changes have been proven time and time again in research and has been demonstrated in our own experiences in Uttarakhand. We further aim to create viable exit routes from such places, as well as prevent institutionalisation whenever possible. In order to do this, we need to understand more fully how people enter the institution, how they leave, and, practically, what are the demographics which describe such people and the assistance they might need. The rationale behind coming up with a status report of the 5 shelter homes managed by the Department of Women’s Welfare across Uttarakhand is to understand the current entry and exit pathways for the women, so we can work together towards alternatives. As well, the intensity of community support must be matched with the developmental needs of the people, including the amount of assistance they will need in everyday life. The report from data collected will help us in understanding the causes leading to women entering the institution. The present report will throw light on demographic (age, cultural background etc.) and non-demographic factors (literacy, health status, severity of disabilities) that may or may not have been a factor in the reasons for entry to and exit from the institution.

How did we do this work? This work was supported by highly collaborative efforts of the staff at each facility, the Department of Women Welfare, Herbertpur Christian Hospital, and a number of Keystone staff who work within the institution itself, as a part of the existing family reunification project on site, called Unity Uttarakhand. A total of 70 questions were identified and information was collected by interviewing the women in the Nari Niketan, speaking with the staff who know them best, and reviewing files. The gaps in the data collection were filled by the 5 Superintendents and supportive staff in the Centres of Uttarakhand – at Almora, Pithoragarh, Haldwani, Kedarpuram, and Kotdwar. Not all of the data is presented in this report but remains available for further analysis. The information and data received are primary and true in nature, to the best of our knowledge, under circumstances which are not ideal. The names of the women and the information is strictly confidential, and no names have been mentioned in the present report. The analysis of the data is done by Keystone team and is solely to understand the status of women in the institution and to use the data in analysing how people come to be in this facility, which we term entrance routes, and the exit routes that are available at this time. In this way, various proactive strategies to divert the women from entrance to the family can be devised, and new ways for people to leave that facilitate better life outcomes for the women. All those collecting data signed a confidentiality agreement to keep all individual information in confidence and private. Any notes or documents were turned over to KII at the end of the mapping, are securely stored, and are considered the property of the Government of Uttarakhand.

Institutional Mapping Report: The Women Welfare and Rehabilitation Centres at Kedarpuram, Kotdwar, Pithoragarh, Haldwani, and Almora

Dates of Visits and Data Dates It should be clearly noted that the mapping data from Nari Niketan Kedarpuram was collected in 2022, and it is by far the largest institution. Changes will have occurred with departures and admissions in the ensuing year, but as a whole, the data remains representative. The data for Almora, Pithoragarh, Haldwani, and Kotdwar was collected in a concentrated two-week period in September 2023 by 4 teams of 2 persons each, who spent multiple days at each facility interviewing the staff, speaking with the women and girls, and examining records. All visits were conducted with excellent partnership between the government staff and the Keystone teams, and we also were greeted with openness and hospitality by the women living in each facility as well as the staff.

About This Report This report is divided into five sections presenting the data from each facility individually, and the 6th sections details 10 recommendations (or paths forward) based on the mapping data.

Institutional Mapping Report: The Women Welfare and Rehabilitation Centres at Kedarpuram, Kotdwar, Pithoragarh, Haldwani, and Almora

The Women Welfare and Rehabilitation Centre at Kedarpuram, Dehradun

About Nari Niketan Kedarpuram, Dehradun, Uttarakhand The Nari Niketan in Kedarpuram, Dehradun is run by the Department of Women Empowerment and Child Development and was established in 1975. In the initial years, it was located in Johnsar Bawar area of Dehradun, and for few years it also functioned from Herbertpur, and in 1998 it was finally shifted to Kedarpuram in Dehradun. Initially the idea was to empower the women engaged in prostitution and in distress by providing them with skills. In 2015/16 a number of improvements were carried out at the Nari Niketan. Major physical site improvements were made, including sanitation, a new kitchen, new bed and

Institutional Mapping Report: The Women Welfare and Rehabilitation Centres at Kedarpuram, Kotdwar, Pithoragarh, Haldwani, and Almora

mattresses, and many others. These renovations were undertaken by the Hans Foundation in collaboration with the Government of Uttarakhand. Perhaps most importantly, the Government of Uttarakhand entered into a Public-Private partnership with Herbertpur Christian Hospital (HCH) to provide all medical services for the past 6 years. At this time, their role has expanded to include nursing, general health care, nutrition and meals, and rehabilitation services. In fact, many of the staff working in the facility now are employees of HCH. There is no question that the state of health care and overall hygiene have improved considerably after HCH took charge. As well in 2016, The Hans Foundation joined with the Government of Uttarakhand to undertake a campaign to improve the physical site. A hygienic kitchen, covered outdoor areas shaded from the sun, new bathhouses, a new toilet block, new beds and bedding, and toilets with privacy from neighbours, as well as an improved entranceway and office space for the staff were all made under this campaign. A number of younger women who were not of legal age also live at Nari Niketan, many of whom were admitted for their protection as a result of exploitation and trafficking. A separate facility for about 20 of these women was created, awaiting their releases as they reach the age of legal majority, and so women without disability were separated out. The strength of Nari Niketan has always been in excess of 100 women, and average entry in a year is approximately 50-60. Yearly exit is reported to be approximately 30-40 women per year, but this number is difficult to track reliably. We do know that between February 2019 and October 2022, 35 women who were residents in 2019 were reunited with their families (during a two-year, nine-month period). There were no proper records kept prior to 2015, hence, it is difficult to gain a clear picture of the entrance routes of all the women, and there is considerable shifting and changing throughout the year. For instance, in 2019, a number of children with developmental disabilities were moved in from the Balika Niketan orphanage next door but were moved back out again shortly because there was no access to education. We did not attempt to capture these sorts of admissions and discharges in this project. In gaining a snapshot of both the demographics, the nature of the disabilities experienced by the women, and the needs they may experience, we were able to look at collected data for 117 women, which is approximately the number of women currently incarcerated in the main Nari Niketan. Because there is flux between the home for typical women and girls in distress, as well as the Balika Niketan institution next door, the number shifts periodically. In addition, there are confusing records because people’s names have been changed during the course of their stay at Nari Niketan. If there were women about whom we were unsure of their identity because of names or for other reasons, we omitted them in these maps. 117 women were included in the information contained in this report, although on any given day the number may be higher. If we could not verify the identity of a person, or there was any risk of confusion between people and their names, we did not include their information.

Institutional Mapping Report: The Women Welfare and Rehabilitation Centres at Kedarpuram, Kotdwar, Pithoragarh, Haldwani, and Almora

Question 1: What do we know about the women living at Nari Niketan Kedarpuram? Understanding basic age data helps up see what sorts of services might be appropriate, and the levels of support which might be necessary in a long-term community support.

Number of Nari Niketan Residents over 65 years:

Average age:

37 years

Number of Nari Niketan Residents under 18 years:

The youngest residents of Nari Niketan are children, and there are two 11-yearold girls

Where do the children come from? Of the 11 girls under the age of 18, 6 have no known prior residence, and 5 came from other institutions (Balika Niketan (2), Selaqui State Mental Health Institute (1), Balika Niketan Almora (1), or an NGO (1). This poses a significant impact in considering appropriate exit plans for this age group. Best practices recognize that children belong in families, and this needs to be a part of all exit planning strategies. For older people, considering the needs of an aging population requires forethought and planning. Of the 18 women and girls under 20 years of age, 6 were transferred from 2 government shelter homes for children (Balika Niketan Dehradun (5) and Almora (1). This means that the government shelter homes are significant feeder institutions for children. The women came to this institution through various channels. 32% of the women were trans-institutionalized from other government institutions, primarily Selaqui Mental Hospital and several in-state institutional Shelter Homes (including Nari Niketan Almora, Balika Niketan Dehradun, Haldwani). It should be noted that, for 22 of the women, where they came from is unknown. We have been told that nearly all were found in the streets locally,

Institutional Mapping Report: The Women Welfare and Rehabilitation Centres at Kedarpuram, Kotdwar, Pithoragarh, Haldwani, and Almora

and many of those same women have a difficult time communicating, so it is difficult to know. To complicate matters further, there are, in some situations, very scant records about admission circumstances.

THE AVERAGE LENGTH OF STAY AT NARI NIKETAN, KEDARPURAM, BY DATE OF ADMISSION IS 6.3 YEARS. THE LONGEST STAY IS RECORDED AS 23 YEARS FOR ONE WOMAN, 2/3 OF HER LIFETIME.

Living Situation Prior to Institutionalization at Nari Niketan Kedarpuram

13%

18%

19%

43%

Selaqui or other State Mental Institution

Unknown

Govt shelter home (Other Nari Niketans)

Family Home

Other NGO

What Geographic Areas do they come from? It is important to note that just because a woman is in this Uttarakhand institution, it does not mean this is their home community or home state. Anecdotally, we learned that they may arrive with migrant families seeking work or have been lost at railway stations on their way from one place to another. Because of the many holy pilgrimage sites which become gatherings of thousands in Uttarakhand, some become lost in the crowd, separated from family, and are unable to communicate or speak the language. Some were brought to holy men for healing in Uttarakhand and became lost because they walked off. Yet others are found dropped at temples or abandoned at holy places or Ashrams. Some families have told us they believe their family member will be better off at Nari Niketan and will be educated or rehabilitated. Our mapping identified that the home states of over 50% of the women are simply unknown.

Institutional Mapping Report: The Women Welfare and Rehabilitation Centres at Kedarpuram, Kotdwar, Pithoragarh, Haldwani, and Almora

Home States 4% 5%

40%

51%

Uttar Pradesh

Uttarakhand

Unknown

Other States (West Bengal, Bihar, J&K, Odisha)

Educational Status Educational Qualifications of 117 Women

Education Attended

Class 12

Class 10

Class 7-10

Class 1-6

No School 0

100

Number of Persons

The chart above shows the actual number of people who have participated in education, ranging from class 1 through class 12. It should be noted that attendance does not mean matriculation or pass. If records are correct, there is one person with a 12th pass credential, and one person with a 10th pass credential. The participation of the people at Nari Niketan in regular education is quite low, with a full 80% having no formal education at all. This does not appear to be tied to age at all. Some of the older residents (50 plus) possess a credential or at least some participation in education, and many of the youngest residents do not. This paints a scenario of an extremely undereducated group of people, and the need for literacy building and adult education.

Institutional Mapping Report: The Women Welfare and Rehabilitation Centres at Kedarpuram, Kotdwar, Pithoragarh, Haldwani, and Almora

Question 2: How much support do the women need? Communication Skills Looking across the population of the institution, 79 out of 117 women at the institution communicate effectively using speech, no matter what language they primarily use, which will be explored later. Five women do not use speech at all, 25 supplement other communication methods using gestural cues. Of the 117 women we explored this topic with, primary languages were identified for 90 of the women as follows: Preferred Language 70

Number of Women

60 50 40 30 20 10 0 Unknown

Hindi

Bengali

Garwali

Primary Language

Jharkhand Local Language

Nepali

Tamil

Urdu

Hindi also

Communication is key both for reunification, as well as establishing trust, developmental growth, and assessing options. 68 of the women assessed speak or understand Hindi as their first language, with Bengali and Garhwali comprising the largest group of people preferring other languages. It is important to note that 4 of the people speak only their first language and do not also speak Hindi, putting them at a great disadvantage.

Institutional Mapping Report: The Women Welfare and Rehabilitation Centres at Kedarpuram, Kotdwar, Pithoragarh, Haldwani, and Almora

Independance in Bathing 70% 60% 50% 40% 30% 20% 10% 0% Completely Independent

Requires Supervision in Shower

Requires Verbal Assistance

Some Physical Assistance

Requires Complete Physical Assistance (Others must do)

Independence in Dressing 70% 60% 50% 40% 30% 20% 10% 0% Completely Independent

Requires Supervision in While Dressing

Requires Verbal Assistance

Some Physical Assistance

Requires Complete Physical Assistance (Others must do)

Independance in Eating Food 70% 60% 50% 40% 30% 20% 10% 0% Completely Independent

Requires Supervision in While Eating

Requires Verbal Assistance

Some Physical Assistance

Institutional Mapping Report: The Women Welfare and Rehabilitation Centres at Kedarpuram, Kotdwar, Pithoragarh, Haldwani, and Almora

Requires Complete Physical Assistance (Others must feed her)

Independence in Personal Grooming 70% 60% 50% 40% 30% 20% 10% 0% Completely Independent

Requires Supervision in grooming

Requires Verbal Assistance

Some Physical Assistance

Requires Complete Physical Assistance (Others must do for her)

Independence with Menstrual Hygiene 70% 60% 50% 40% 30% 20% 10% 0% Completely Independent

Requires Supervision in menstrual care

Requires Verbal Assistance

Some Physical Assistance

Requires Complete Physical Assistance (Others must do for her)

Independence in Using Toilet

92%

Requires Assistance in Using Toilet

Completely Independent

Institutional Mapping Report: The Women Welfare and Rehabilitation Centres at Kedarpuram, Kotdwar, Pithoragarh, Haldwani, and Almora

From this information emerges the fact that intensive support in the form of personal care is required for a very significant number of the women. For community services, this means providing not only personal assistance to about half of the women to day-to-day bodily care and basic needs, but also a focus on teaching the skills needed to perform, some or all of these everyday tasks independently. As well, because some of the women are in their middle and older years, any plans for community living must include recognition that more support in personal care may be needed due to competency losses that accompany the aging process. For many of the women, more than half, it is clear that they are completely independent in most if not all areas of bodily and personal care.

Number of Women who walk/get around

Mobility and Support Needs

Independently

104 104

Not including stairs

With physical assistance

Using a wheelchair

The above information demonstrates that accessible housing, or at least one-floor living, is required for at least 11 of the women, with three women who will require full accessibility. It should also be noted that with some of the older women, one floor living is highly desirable for safety and to assure that housing will remain safe and appropriate over the years.

Question 3: Diagnostics and Labels The diagnostic labels assigned to women were collected from files and records, and from interviews with the medical and administrative staff. Simply put, many of the women carry multiple labels, and have a complicated clinical picture. To begin with, of the 117 women for which this information is available, the following data appears to be accurate, although it is important to note that an official disability certificate does not exist for most of the women, nor does record of testing results or how the diagnosis was gained.

Institutional Mapping Report: The Women Welfare and Rehabilitation Centres at Kedarpuram, Kotdwar, Pithoragarh, Haldwani, and Almora

Of surveys used for this report, the following represents the diagnosis and labels. Some women carry more than one. Diagnostic Label

Percentage of Women carrying Label

Intellectual Disability

25%

Major Mental Health Diagnosis (schizophrenia, bipolar disorder, major depression)

Psychosis

31%

Speech Impairment

Hearing Impairment

Under Observation

It should be noted that of the several people listed as ‘under observation’, 3 have been at Nari Niketan for over two years. There are several other conditions noted, including old age, burn victims, leprosy, autism, and seizure disorders, but these were listed for a very few people. Of the total of 25 women described as having a developmental disability (defined as intellectual disability, cerebral palsy, autism and multiple disabilities), the estimated “level” of disability is as follows: Impact of Developmental Disability

48%

29% Moderate

Mild

22%

Severe

This is a largely subjective area, but the estimation of impact of disability – mild, moderate, or severe- shed some limited light on the amount of support the women with intellectual disabilities will need in community settings.

Institutional Mapping Report: The Women Welfare and Rehabilitation Centres at Kedarpuram, Kotdwar, Pithoragarh, Haldwani, and Almora

Use of Psychotropic Medications Most people at Nari Niketan, 86% to be precise, are taking antipsychotic medications (Risperidone, Olanzapine, or Clozapine, and a handful of others), and over 25% are prescribed 2 or even 3 different neuroleptic medications stacked together. Of course, these medications impact on activity level, general health, behavior, and functional ability. The stressfulness of the environment, the numbers of people living together, and the profound feelings of sadness and rejection that many of the women speak of contributes to this picture. They also, for many women, represent a sense of the financial and social impact of taking such medications after discharge from Nari Niketan. We also can add that one of the contributors of the disintegration of family reunifications is the abrupt stop of such medications without oversight. Sometimes this happens at the advice of faith healers, sometimes it is due to long treks to visit pharmacies or clinics, sometimes for financial reasons, and sometimes at the insistence of the person herself.

Question 5: Citizenship and Benefits Personhood and identity are defined in some ways by holding official identity in the eyes of the people, the community, and the state. Aadhaar card is the necessary identification one must hold in order to avail any community resources outside the institution. As well, voter ID card and disability certificate are keys to both participating in civic life as well as gaining access to essential rightful benefits available to people with disabilities in India. The following table indicates the percentages of women who hold such benefits:

Families have been in contact by phone or email

12%

Family contact information is unknown

21%

Institution staff believe family unification is possible

21%

No family contact since placement

85%

Institutional Mapping Report: The Women Welfare and Rehabilitation Centres at Kedarpuram, Kotdwar, Pithoragarh, Haldwani, and Almora

Family reunification considered averse to well-being

Identification Forms Held Percentage of People Who Hold ID

100% 90% 80% 70% 60% 50% 40%

37%

35%

30% 20%

11%

10% 0%

2% Aadhaar Card Holder

Voter

Applied for Disability Card

Disability Card

Type of Identification

Question 6: A Snapshot of Exit Paths We have the unique ability to have a closer look at the particulars of 35 women who were at Nari Niketan Kedarpuram as of February 2019, but were discharged from the facility over the course of the next 3 years. These were all people who were considered for the Community Lives Project which opened in 2019, so offers us a window to where people went when they left the facility. We were able to individually follow-up with most of the individuals or their families to determine their standing. The three “exit pathways” for these 35 women are as follows: Exit Pathways for the Cohort of 35 Women and Girls 1 person passed away of unknown causes at 32 years of age

3 children and teenagers were institutionalized at children's homes

23 women were reunified with their families

8 women moved into an integrated community living program in Herbertpur

Other Residential Institution/NGO

Integrated Community Home

Reunified with Family

Died

Institutional Mapping Report: The Women Welfare and Rehabilitation Centres at Kedarpuram, Kotdwar, Pithoragarh, Haldwani, and Almora

Family reunification numbers are high, with 66% of the cohort leaving Nari Niketan through this exit path. However, the results of such family reunifications cannot be determined. An analysis is below, but more than 50% of the families are unreachable, most with disconnected numbers, or, in two situations, placed out of the country in Nepal, and Bangladesh. Only 35 % of the families are still together, and several of these are under significant stress. Access to medications, poor health, difficulty traveling to medical centres for mental health treatment, and impoverishment are noted as significant stressors within the family. Of the 23 people who were reunited with their families, and follow-up reveals the following: Of the 23 Women Reunified with Family 1 woman left the home and is known to be wandering

2 passed away shortly following reunification

8 are still living with family

12 families are unreachable

Passed away

Verified with family

Unreachable

Wandering

This data reveals the dire need to follow-up with families, making sure that a support package in in place, and track well-being of the women over the long term. The women who passed away shortly after reunification were 41 years old and 58 years old, respectively. There is no notation of how they died.

Institutional Mapping Report: The Women Welfare and Rehabilitation Centres at Kedarpuram, Kotdwar, Pithoragarh, Haldwani, and Almora

The Women Welfare and Rehabilitation Centre at Kotdwar

About the Women Welfare and Rehabilitation Centre at Kotdwar The Government Women Welfare and Rehabilitation Centre at Kotdwar (formerly called Nari Niketan Kotdwar) was originally established in 1996 in Moti Dhana as a facility to serve minor girls under the age of 18 who were separated from their families for any reason. This original facility was located only one KM away from the current facility which was built in 2013. It is designed to house up to 25 people, but there are 14 actual beds, and 14 is the largest number of people who have ever stayed there, according to the staff. Although contained in one building, it actually houses three separate facilities. The Rehabilitation Centre (Program 1) is designed to house and care for destitute women, and caters to women with disabilities, although they try to shift women with disabilities to Institutional Mapping Report: The Women Welfare and Rehabilitation Centres at Kedarpuram, Kotdwar, Pithoragarh, Haldwani, and Almora

the Women Welfare and Rehabilitation Centre at Kedarpuram, Dehradun (formerly Nari Niketan Dehradun) The Observation Unit (Program 2) is to house women on a short-term basis (one month or less) to make a determination about where to go from there. From here, people can be shifted to the Place of Safety, or to the Rehabilitation Centre, home with families, or other facilities. The Place of Safety (Program 3) is designed to house and serve underage young women who are involved in cases with the court as offenders, awaiting convictions, sentencing, and remanding to adult prison when they turn of legal age. On the days of our visits, there was no one staying in the Observation program, two young women in the Place of Safety, and three adults and one infant in the Rehabilitation Centre. Although there were two sleeping areas to separate the people living at the Place of Safety, the two groups shared space with little distinction, as the census is very low. The third program, the Observation Unit, was not being utilized, and has not been used frequently since establishment. In fact, the unused upstairs rooms are supposed to be the resident room for the Rehabilitation Centre, but those 3 women and the baby stay in the currently vacant Observation Unit for practical reasons.

Question 1: What do we know about the women living at Nari Niketan Kotdwar? Understanding basic age data helps up see what sorts of services might be appropriate, and the levels of support which might be necessary in a long-term community support. Number of Nari Niketan Kotdwar Residents over 65 years:

Average age of adults:

40 years (range 35-48)

Number of Nari Niketan Kotdwar Residents under 18 years:

Institutional Mapping Report: The Women Welfare and Rehabilitation Centres at Kedarpuram, Kotdwar, Pithoragarh, Haldwani, and Almora

The youngest resident of Nari Niketan is a baby of approximately 14 months old

Where did the child come from? The baby was brought to Kotdwar along with his mother, who cares for him within the facility. The mother is 35 years old, has 5 other children she is currently separated from. Both the baby and the mother have been referred to the Kedarpuram facility, where separation is a strong possibility.

Living situation prior to Kotdwar facility

33%

The women came to this institution through three channels – all were found on the streets at some point and brought by police through a Selaqui mental hospital court order. One person was trans-institutionalized after a brief stay in another government mental health facility.

33%

Family home

Unknown

It is important to note that one of the women said that the last place she lived was her family home, but it appears that for about 6 years she was in and out of the family home, sometimes for extended periods of time.

What Geographic Areas do they come from? It is important to note that just because a woman is in this Uttarakhand institution, it does not mean this is their home community or home state. Of the three adults, we were able to discern that she is from Odisha, but this was only discovered during our visit because we were able to identify the language that she understood. She was able to confirm this through a video call with an Odia speaker during our interview. The other two women hailed from over the border in Uttar Pradesh.

Home States: 3 women at Kotdwar

33%

Uttar Pradesh Odisha

66%

Institutional Mapping Report: The Women Welfare and Rehabilitation Centres at Kedarpuram, Kotdwar, Pithoragarh, Haldwani, and Almora

THE AVERAGE LENGTH OF STAY FOR THE THREE ADULTS AT NARI NIKETAN KOTDWAR BY DATE OF ADMISSION IS 34 MONTHS. FOR THE TWO WOMEN WHO HAVE BEEN THERE OVER 4 YEARS, THERE IS NO DISCHARGE IN SIGHT, AND THE THIRD PERSON AND HER BABY ARE LIKELY TO BE TRANSFERRED TO ANOTHER FACILITY

Educational Status Educational Attainment of the Three Kotdwar Residents

Educational Completed

No School Class 1-6 Class 7-9 Class 10 Class 12

Number of persons

Question 2: How much support do the women need? Communication Skills Looking across the population of the institution, three of the women at the institution communicate effectively using speech, no matter what language they primarily use, which will be explored later. Of the three women we explored this topic with, primary languages were identified for each of the women as follows:

Institutional Mapping Report: The Women Welfare and Rehabilitation Centres at Kedarpuram, Kotdwar, Pithoragarh, Haldwani, and Almora

Preferred Languages Spoken/Understood

Number of Persons

0 Hindi

Odia Primary Languages Primary and Secondary Languages

Hindi Secondary Languages

Communication is key both for reunification, as well as establishing trust, developmental growth, and assessing options. Two of the women assessed understand and speak Hindi, with one of them speaking a small bit of Urdu. However, one person has lived at the facility since 2019, and her primary language was unknown. She has picked up a little Hindi but is mostly non-verbal because she has so little Hindi. However, while interviewing her, we were able to identify that she speaks and understands Odia and gained important background information by having an Odia speaker talk with (with permission) over mobile phone.

Independence in Everyday Life Skills In order to determine the amount of support each person would need to live outside the institution, it is important to assess the assistance which would be required in many daily living skills. For this process, we selected level of independence in bathing, dressing, menstrual care, eating, personal grooming, and toilet use. Independence Level in Activities of Daily Living Using toilet

ADL Skills

Menstrual care Grooming and brushing Care of bedding Eating Dressing Bathing Cooking preparation 0%

20%

40%

60%

80%

100%

Percentage of Independence

Institutional Mapping Report: The Women Welfare and Rehabilitation Centres at Kedarpuram, Kotdwar, Pithoragarh, Haldwani, and Almora

From this information emerges the fact that this institution serves people who can take care of their own basic care skills with only small amount of assistance. This will be essential information whether they are reunified with their families (which is a real possibility for all of them) or whether they are served in a supported living model. Intensive support in the form of personal care is not required for any of these women. We were unable to assess cooking skills, as there is no opportunity for them to do so at this facility. However, all of the women who could communicate with us noted in their interview that they do know how to cook and enjoy it as well. They are completely independent in most if not all areas of bodily and personal care. This paints a very different picture of support needs than at the Nari Niketan Kedarpuram facility.

100% of the adults at the Kotdwar Facility ambulate independently, and are fully able to go up and down stairs, and navigate rough terrain safely. There are no mobility support needs.

The above information demonstrates that accessible housing, or at least one-floor living, is not required for any of the women, and given their ages, that is likely to remain accurate for the foreseeable future.

Question 3: Diagnostics, Labels and Medications This area differs significantly from the clinical picture at Nari Niketan Kedarpuram. None of the women carry any official psychiatric or medical diagnosis, and none of them take any medications, psychiatric or otherwise. The staff guess that two of the three women likely have a developmental disability, but this is only non-assessed informal opinion. No one has a disability certificate, nor an assessment. One person spent time at a mental hospital, was labelled with psychotic NOS several years ago, but there is no diagnosis. Non-clinical interviewers note that a comprehensive psychiatric evaluation could be helpful in helping her to regain her memory. At the same time, we must recognize that a brief interview with unknown people is a stressor, and people may be quite anxious with good reason. The staff categorize the estimated level of intellectual disability, which is a largely subjective area, but the estimation of impact of disability is mild – so this sheds some limited light on the amount of support the two women with intellectual disabilities will need in community settings.

Institutional Mapping Report: The Women Welfare and Rehabilitation Centres at Kedarpuram, Kotdwar, Pithoragarh, Haldwani, and Almora

STAFF INFORMALLY SUGGESTED THAT TWO OF THE THREE ADULT WOMEN HAVE A MILD INTELLECTUAL DISABILITY. THIS IS IMPORTANT WHEN PLANNING FUTURE SUPPORT BECAUSE THEY MAY BE EASILY MANIPULATED OR CONTROLLED BY OTHERS, AND SAFEGUARDING AGAINST THIS WILL BE REQUIRED.

Use of Psychotropic Medications Again, in sharp contrast to the Nari Niketan in Kedarpuram, Dehradun, no one takes psychotropic medication, or any other medication. This is likely because no physician or psychiatrist sees them, and medical care is only available at the local hospital.

Question 4: Family Relationships We solicited information on frequency and method of family contacts, staff perspectives on the likelihood of reunification, and whether reunification would be positive for the person. Drawing from the records as well as the opinions of the staff, the following information has been gleaned. Based on our limited information, family reunification is a possibility for all the women, but especially for one woman from Odisha, we were able to discern her language, and also gain the names of several villages in Odisha that she mentioned. With the other women, there is also hope that reunification is a possibility with good support.

Families have been in contact by phone or email

33% (Initiated by staff)

Family contact information is unknown

66%

No family contact with person since placement

100%

Institutional Mapping Report: The Women Welfare and Rehabilitation Centres at Kedarpuram, Kotdwar, Pithoragarh, Haldwani, and Almora

100% 80% 60% 40% 20% 0%

Aadhaar Card

Voter Card

Disability Card applied for

Disability Card holder

Type of ID

Question 6: A Snapshot of Exit Paths We have the unique ability to have a closer look at the particulars of 28 women who were at Nari Niketan Kotdwar from 2015 onwards but were discharged from the facility over the course of the next 8 years. This important information offers us a window to where people went when they left the facility. The three “exit pathways” for these 28 women are as follows: Exit Pathways for 28 Kotdwar Women Since 2015 Trans Institutionalized to Other Nari Niketans

Released on her own Recognizance

3% 15%

82%

Institutional Mapping Report: The Women Welfare and Rehabilitation Centres at Kedarpuram, Kotdwar, Pithoragarh, Haldwani, and Almora

Reunified with Family

These numbers show a much higher rate of reunification than the 66% at Kedarpuram, however, there was no way to verify if any of these reunifications have lasted over time, or if the women were later re-institutionalized anywhere. This is an excellent area to strengthen in the future. We were unable to verify with any families whether they are still whole as contact information was not available. This data reveals the dire need to follow-up with families, making sure that a support package is in place, and well-being of the women is tracked over the long term.

Institutional Mapping Report: The Women Welfare and Rehabilitation Centres at Kedarpuram, Kotdwar, Pithoragarh, Haldwani, and Almora

The Women Welfare and Rehabilitation Centre at Pithoragarh

About Nari Niketan Pithoragarh, Uttarakhand The Government Women Skill Development and Training Centre at Pithoragarh (Run by the Women Welfare Department) was established in the late 1960s, as a facility to provide skill enhancement training for the empowerment of women and girls who were affected by the Sino-Indian War. The institute was operated in both residential, as well as nonresidential form. When it began functioning, the women and girls were provided vocational training including wool looming, knitting, stitching, weaving, etc. The institute later became purely residential training centre from the mid-70s. Presently, the institute is a residence for women facing vulnerabilities.

Institutional Mapping Report: The Women Welfare and Rehabilitation Centres at Kedarpuram, Kotdwar, Pithoragarh, Haldwani, and Almora

It is designed to house up to 15 people, and presently, the institute has 13 beds, while at present there are 12 residents. The single building has 3 floors, with the ground floor being the administrative unit, the first floor being the residential unit and the top floor houses a dining area, kitchen, recreation room and a training room. The residents at the centre have their morning tea at 7 AM, and then engage in self-care and cleaning activities and get the breakfast at 8:30 AM. From 9 AM the training sessions begin for the residents. At 11:30 AM, fruits are provided to the residents and the training sessions commence. A few residents also help the kitchen staff with cooking. At 1 PM they have lunch. Following that, few residents take rest and the remaining residents either watch TV or play games. Few residents would continue doing the training activities. At 3 PM the residents are given tea and at 7 PM, dinner is served. There have been 3 new admissions since January 2022 and 2 of them have been reunified with families. There hasn’t been any reported death within the premises in the last 5 years.

Question 1: What do we know about the women living at Nari Niketan Pithoragarh? Understanding basic age data helps up see what sorts of services might be appropriate, and the levels of support which might be necessary in a long-term community support.

Average age of adults:

Number of Nari Niketan Pithoragarh Residents over 65 years:

47 years (range 25-81)

Number of Nari Niketan Pithoragarh Residents under 18 years:

Institutional Mapping Report: The Women Welfare and Rehabilitation Centres at Kedarpuram, Kotdwar, Pithoragarh, Haldwani, and Almora

Living Situation Prior to Pithoragarh Facility

Unknown

25%

51%

Trans Institutionalized from Almora Facility for Children

With Family

16%

8% Trans Institutionalized from Selaqui Mental Hospital

The women came to this institution through three channels – 25% (3 women) were trans institutionalized from either the children’s facility in Almora, or Selaqui Mental Hospital, while 51% (6) came from their families. For the remaining 25% (3 women), it is not clear where they came from. There are indications from some of the women that they fled abusive situations or were trafficked.

What Geographic Areas do they come from? Pithoragarh stands out from the other shelter homes because it serves mostly women from Uttarakhand itself. It is important to note that just because a woman is in this Uttarakhand institution, it does not mean this is their home community or home state. This is likely due to the remoteness of the location, and it can facilitate family reunification or other service development. Also, unlike most other institutions we are mapping, family contact or at least known location is more common, as they have not been uprooted from their home communities as much as happens elsewhere.

Unlike other institutions we are studying, it appears that 92% of the women living here identify as from Uttarakhand itself. Only one person is said to be from neighbouring Uttar Pradesh.

Institutional Mapping Report: The Women Welfare and Rehabilitation Centres at Kedarpuram, Kotdwar, Pithoragarh, Haldwani, and Almora

How Long do they Stay at the Pithoragarh Facility? Unlike Kotdwar, there are many very long-stay residents at this facility. Again, this may be due to the remote location of the site, combined with the lack of family support resources to reunite the women with their local families. One can see the length of time each person has lived at this facility in this chart, showing years of lost community life experiences. Because there are no real possibilities for those who have been at the facility for 3 or more years without renewed effort, we can hypothesize 5 women will join the two women at the top of the chart who have nearly 45 combined years in a locked facility.

THE AVERAGE LENGTH OF STAY FOR THE TWELVE RESIDENTS AT NARI NIKETAN PITHORAGARH BY DATE OF ADMISSION IS 6 YEARS. TWO WOMEN HAVE LIVED THERE 19 AND 25 YEARS, RESPECTIVELY.

The twelve women living at Pithoragarh

Years of Institutionalization at Pithoragarh 1

Institutional Mapping Report: The Women Welfare and Rehabilitation Centres at Kedarpuram, Kotdwar, Pithoragarh, Haldwani, and Almora

Educational Status Educational Attainment of the Women at Pithoragarh Senior Secondary (Up to 12th class)

1 0

Up to 10th class Secondary (class 6-8)

Primary (class 1-5)

2 4

No Education 3

Unknown 0

0.5

1.5

2.5

3.5

4.5

The chart above shows the actual number of people who have participated in education, ranging from class 1 through class 12. It should be noted that attendance does not mean matriculation or pass. If records are correct, 5 of the three women have some formal education, with a note that the person who was transferred from Selaqui has a 12th class education.

Question 2: How much support do the women need? Communication Skills Looking across the population of the institution, 10 of the women at the institution communicate effectively using speech, all in Hindi. Two of the women communicate using sign language or gestures but have no oral speech. Of the 3 women we explored this topic with, primary languages were identified for each of the women as follows: Primary and Secondary Languages of the Women at Pithoragarh 12

Number of Women

8 6

4 2

2 0

1 Hindi (Primary)

Sign/gestures (primary)

Nepali (secondary

Primary and secondary languages

Institutional Mapping Report: The Women Welfare and Rehabilitation Centres at Kedarpuram, Kotdwar, Pithoragarh, Haldwani, and Almora

1 Kumaoni (secondary)

English (secondary)

Communication is key both for reunification, as well as establishing trust, developmental growth, and assessing options. Further questions include whether actual Indian Sign language is use by the two women, or if personal gestures are being considered sign language. Augmentative communication may be helpful ways forward for these women. It is also possible that Kumaoni is a more comfortable language for the 5 women for whom it is reported as a secondary language, but that again will need to be investigated.

Percentage of Independance

100

Cooking preparation

Bathing

Dressing

100

80 70 60 50 40 30 20 10 0

Eating

Care of bedding

Grooming and brushing

Menstrual care

Using toilet

ADL Skills

From this information emerges the fact that this institution serves people who can take care of their own basic care skills with only a very small amount of assistance required, even less that the women at Kotdwar. This will be essential information whether they are reunified with their families or whether they are served in a supported living model. Intensive support in the form of personal care is required for none of these women. We were unable to assess cooking skills beyond cooking preparation (cutting, peeling etc.) as there is no opportunity for them to do so at this facility. They are completely independent in most if not all areas of bodily and personal care. This paints a very different picture of support needs than at the Nari Niketan Kedarpuram facility. As for mobility, 10 of the women are freely mobile, including steps and rough terrain, while two require the assistance of a walker or a person beside them to assist.

Institutional Mapping Report: The Women Welfare and Rehabilitation Centres at Kedarpuram, Kotdwar, Pithoragarh, Haldwani, and Almora

83% of the adults at the Pithoragarh Facility ambulate independently, and are fully able to go up and down stairs, and navigate rough terrain safely. One person uses a walker, and would need assistance with stairs. Another person requires physical assistance in the form of a person walking with her to walk, possibly due to vision impacted by accident.

The above information demonstrates that accessible housing, or at least one-floor living, may be required for two of the women, and given their ages, that is likely to remain accurate for the foreseeable future.

Question 3: Diagnostics, Labels, and Medications Three of the women carry a psychiatric diagnostic label (Schizophrenia, Persistent Delusional Disorder, and Trichotillomania). Four women take psychiatric medication, three of whom are given a poly pharm, layering combination of anti-psychotic, anti-seizure, and anti-anxiety psychiatric medications. This again is a departure from what we saw at Kotdwar and is likely because of the ages of the women combined with the availability of medical professionals and medications.

Conditions and Medications of the 12 women at Pithoragarh 100%

80%

60%

40%

Taking medications for general health

Taking psychiatric medication

33 25 16

20%

0% Psychiatric diagnosis

Diagnosis of developmental disability

Speech and hearing disability

Institutional Mapping Report: The Women Welfare and Rehabilitation Centres at Kedarpuram, Kotdwar, Pithoragarh, Haldwani, and Almora

Question 4: Family Relationships We solicited information on frequency and method of family contacts, staff perspectives on the likelihood of reunification, and whether reunification would be positive for the person. Drawing from the records as well as the opinions of the staff, the following information has been gleaned. Because the facility to local to so many of the women and their family in this remote area, it makes sense that there would be more family contact. Regardless of whether family reunification is a possibility, family support and connection is an excellent asset for women looking to re-establish themselves in community.

1/3 OF THE WOMEN TAKE MULTIPLE PSYCHO-ACTIVE MEDICATIONS. SAFEGUARDING AGAINST THIS WILL BE REQUIRED.

Data on Family Contact Families have been in contact with facility

Family reunification seems possible and likely

Family reunification seems unlikely and impossible

Family contact unavailable

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Institutional Mapping Report: The Women Welfare and Rehabilitation Centres at Kedarpuram, Kotdwar, Pithoragarh, Haldwani, and Almora

Identification Cards Held or Applied For Percentage of women who hold ID cards

100 90 80 70 60 50 40

30 20 10 0

Aadhaar card

Voter card

Disability card applied for

Disability card holder

Type of Identification

Question 6: A Snapshot of Exit Paths We have the unique ability to have a closer look at the particulars of 27 who were at Nari Niketan Pithoragarh from 2015 onwards but were discharged from the facility over the course of the next 8 years. This important information offers us a window to where people went when they left the facility. Again, family reunification rates are Exit Pathways for the 27 Women Discharged from Pithoragarh since 2025 comparable to Kotdwar, but the success of these reunifications is completely unknown. There are no follow-up Trans Institutionalized 24% contacts, and we were unable to track down families to find out if they are still together due to lack of contact information. There remains was no way to verify if any of these reunifications have lasted over time, or if the women 76% were later re-institutionalized anywhere. Went Home This is an excellent area to strengthen in with Families the future. We were unable to verify with any families whether they are still whole as contact information was not available. This data reveals the dire need to follow-up with families, making sure that a support package in in place, and track well-being of the women over the long term. The trans-institutionalization rate is high – but that is due in part to three teenagers who were transferred to children’s institutions within a year or so after their admission. Three adult women (1 presumed) were sent to the Kedarpuram Facility in Dehradun, and the reason is not clear.

Institutional Mapping Report: The Women Welfare and Rehabilitation Centres at Kedarpuram, Kotdwar, Pithoragarh, Haldwani, and Almora

The Women Welfare and Rehabilitation Centre at Haldwani

About Nari Niketan Haldwani, Uttarakhand The Government Women Welfare and Rehabilitation Centre at Haldwani (formerly known as Nari Niketan, Haldwani) was originally built in 1956, for women rescued from sex trafficking. It later started taking destitute women too, but the time frame for this is unclear. The building is now due for renovation. It is intended for up to 25 women though currently there are only 19 women. However, the total number of actual beds in the premises found was 16. The building has 2 sections with 8 beds each, and 1 room which was being used for the vocational section. Most of the women spend time in the courtyard between the 2 buildings. It also has 1 room on the front side, which was being shared by 2 women (one with children and the other with a pregnancy). The courtyard also has toilets on one side, which are shared by staff and the women. The program in itself was in 3 parts. The Rehabilitation Centre (program 1) is for women above 18, (the oldest one being 62, and the youngest is 23 years old) who have been on the streets and were brought to the facility by the police. Reunification has been attempted for all of them, and reunification has been especially difficult for women who have speech and hearing impairment.

Institutional Mapping Report: The Women Welfare and Rehabilitation Centres at Kedarpuram, Kotdwar, Pithoragarh, Haldwani, and Almora

The POCSO (Protection of Children from Sexual Offences) Unit (program 2) house women below 18 years of age, (the youngest being 13 years old), who have been living there and will stay till they are 18, after which they are free to go. Some can be reunited to their families if the family desires. Some of the women are those who have married before the age of 18. One woman was 6 months pregnant, and we were informed that young girls who were victims of rape and incest have come to the facility as well. JJ Act Unit (program 3). The institution also houses women under the age of 18, who are involved in cases, under the Juvenile Justice Act and are waiting for convictions, sentencing or being remanded to adult prisons when they turn of legal age. There were no women in the premises under the JJ Act Unit during the time of our visit.

The Process After the initial discussion with the superintendent, we were given the files of the women. As with the other institutions, we collected information only for the women in the rehabilitation centre (Program A). One staff was always available with us to answer questions and guide us. We initially filled Part 1 and 2 from the files and with inputs from the staff. We then conducted interviews of the women with the staff and superintendent present.

Question 1: What do we know about the women living at Nari Niketan Haldwani? There are 20 adults and children living in the Woman Welfare Centre at Haldwani, and they range in age from 3 months to 62 years old. Of those 20, 8 are young person there for protection under the POCSO Act, and they are teenagers. We include their data only for this first section because they form an important part of the picture at this institution. Understanding basic age data helps up see what sorts of services might be appropriate, and the levels of support which might be necessary in a long-term community support. Average age of adults (18 plus):

Number of Nari Niketan Haldwani Residents over 65 years:

37 years

(range 23-62)

Number of Nari Niketan Haldwani Residents under 18 years:

(range 3 months to 17 years)

Institutional Mapping Report: The Women Welfare and Rehabilitation Centres at Kedarpuram, Kotdwar, Pithoragarh, Haldwani, and Almora

Age Spread of the 20 Women and Children at Haldwani in Rehabilitation Center and POCSO Program Number of People

10 8

8 6

4 2 0

1 0

1 year or below

1-10 years

11-20 years

21-30 years

31-40 years

41-50 years 51-60 years

61-70 years

Category by Age

The age spread at this institution is much younger than the others, even though this is not a children’s institution. The three youngest children (age 3 months, 3 years, and 7) are institutionalized along with their mothers. As for the women in the Rehabilitation Centre only, they range in age from 3 months to 62 years of age. Living Situation Prior to Institutionalization at Haldwani Trans Institutionalized (from Rudrapur facility), 1

With Family, 1

11%

78% Unknown, 7

Of the 9 adult persons living in the rehabilitation centre, all came from their family homes, or were found on the streets with the exception of one person, who was trans institutionalized because the facility in Rudrapur, Uttarakhand, in which she was living was closed. The women came to this institution through three channels, but due to challenges in communication, the home communities and where they were living when they entered the institution is difficult to ascertain. Their home communities, roughly, appear to be Uttarakhand communities, based on the information we have available.

Institutional Mapping Report: The Women Welfare and Rehabilitation Centres at Kedarpuram, Kotdwar, Pithoragarh, Haldwani, and Almora

Unlike other institutions we are studying, it appears that 100% of the women living here identify as from Uttarakhand itself. This is difficult to know for certain, as there is little record for some of the women, and numerous communication challenges.

What Geographic Areas do they come from? How Long do they Stay at the Haldwani Facility? This facility functions very differently from the others we are mapping, as they length is brief and must be measured in days rather than years. Unlike any of the institutions we are mapping in Uttarakhand, the stay of the current 9 adult women in the rehabilitation averages only 1.3 years. This was correlated by reviewing the record of women who have been discharged support resources to reunite the women with their local families. Of 20 women who were discharged in the last year, the average length of stay was only 45 days. 30% of them were transferred to other institutions, and 25% were released independently, and 45% were released to their families.

THE AVERAGE LENGTH OF STAY FOR THE ADULTS IN THIS FACILITY IS ONLY 1.3 YEARS SO FAR, WHICH IS MIRRORED BY THE FACT THAT THE HISTORICAL AVERAGE LENGTH OF STAY HERE IS ONLY 45 DAYS. THIS FACILITY OPERATES VERY DIFFERENTLY FROM THE OTHER 4 UTTARAKHAND INSTITUTIONS.

Institutional Mapping Report: The Women Welfare and Rehabilitation Centres at Kedarpuram, Kotdwar, Pithoragarh, Haldwani, and Almora

Educational Status Educational Attainment of the Adult Women at Haldwani facility

Educational Participation

Senior secondary (up to 12th class)

Up the 10th class Secondary (up the 8th class)

Primary 1st-5th class

No Education

Unknown

3 0

Number of Women

Question 2: How much support do the women need? Communication Skills Looking across the population of the institution, of the women at the institution communicate effectively using speech, all in Hindi. Three of the women communicate using sign language or gestures but have no oral speech. One person elects not to speak. Of the 3 women we explored this topic with, primary languages were identified for each of the women as follows: Primary and Secondary Languages 7

Number of women

6 5 4

3 2 1 0

Unknown

Hindi (primary)

Tibetan Sign/gestures (secondary) (primary)

Kumaoni (secondary)

English (secondary)

Urdu (secondary)

Badhaiyun (secondary)

Institutional Mapping Report: The Women Welfare and Rehabilitation Centres at Kedarpuram, Kotdwar, Pithoragarh, Haldwani, and Almora

Activities of Daily Living Skills

Using toilet

100

Care of personal belongings

Menstrual care

Grooming and brushing

Care of bedding

Eating

100

Dressing

Bathing

86 100

Cooking preparation 0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Independence Level

The women here require little assistance in basic daily skills. We were unable to assess cooking skills beyond cooking preparation (cutting, peeling etc.) as there is no opportunity for them to do so at this facility. They are completely independent in most if not all areas of bodily and personal care. As for mobility, 100% of the women are freely mobile, including steps.

Question 3: Diagnostics, Labels, and Medications Four of nine women carry a psychiatric diagnostic label (Schizophrenia, Bipolar Disorder, or psychosis). Five of nine women take psychiatric medication, but there is less indication that poly-pharm is extensive. Two persons are taking more than one psychiatric medication, and in one situation, they are to treat two separate conditions. In contrast to the women at the other facilities, these are women not labelled with a developmental or intellectual disability, who are independent in most basic self-care skills, and who appear to have spent less of their lives in institutions. As well, they are likely to either be discharged or transferred to a long-stay facility if they are not quickly discharged to family or community.

Institutional Mapping Report: The Women Welfare and Rehabilitation Centres at Kedarpuram, Kotdwar, Pithoragarh, Haldwani, and Almora

Conditions and Medications of the 9 Women at Haldwani 1

Percentage of Persons

0.9 0.8 0.7 0.6 0.5

55%

44%

0.4 0.3

22% 16%

0.2 0.1

0 Psychiatric Diagnosis

Diagnosis of Developmental Disability

Taking medications for general health

Speech and Hearing Disability

Taking Psychiatric medication

Question 4: Family Relationship We solicited information on frequency and method of family contacts, staff perspectives on the likelihood of reunification, and whether reunification would be positive for the person. Drawing from the records as well as the opinions of the staff, the following information has been gleaned. Data on Family Contact and Perceived Reunification Likelihood at Haldwani 70%

60% 50% 40% 33

Family reunification seems possible and likely

Families have been in contact with facility

30% 22 20% 10% 0% Family contact information unavailable

Family reunification seems unlikely and impossible

These numbers are more positive than in any of the other institutions we are mapping. It is likely because the facility appears to be functioning as a short-term stay, and the disabilities and competency deficits people experience are less than other facilities. As well, they have simply not been separated from their families for long, and the experiences of other women tell us they will either get placed back with their families or they will be sent to another institution which functions as a long-stay institution.

Institutional Mapping Report: The Women Welfare and Rehabilitation Centres at Kedarpuram, Kotdwar, Pithoragarh, Haldwani, and Almora

Question 5: Citizenship and Benefits Personhood and identity are defined in some ways by holding official identity in the eyes of the people, the community, and the state. Aadhaar card is the necessary identification one must hold in order to avail any community resources outside the institution. As well, voter ID card and disability certificate are keys to both participating in civic life as well as gaining access to essential rightful benefits available to people with disabilities in India. Again, much could be done in this area to start these women availing their benefit. Identification Cards Held or Applied for by Women at Haldwani 100% 90% 80% 70% 60% 50% 40% 30% 20%

10%

Voter Card

Disability card applied for

Disability card holder

0% Aadhaar Card

Question 6: A Snapshot of Exit Paths Again, family reunification rates are high compared to all other institutions, but the success of these reunifications is completely unknown. There are no follow-up contacts, and we were unable to track down families to find out if they are still together due to lack of contact information. There remains was no way to verify if any of these reunifications have lasted over time, or if the women were later re-institutionalized anywhere.

Exit Pathways for 33 Women Discharged from Haldwani since 2022 Released on own Recognizance

Nari Niketan Kedarpuram Andhra Pradesh Institution

15%

6% 3% 6%

Nari Niketan Almora

70% Reunified with Family

The trans-institutionalization rate is high as well, 33%, and that is consistent with the fact that this operates as a short stay institution, and those who are not easily reunified get institutionalized elsewhere.

Institutional Mapping Report: The Women Welfare and Rehabilitation Centres at Kedarpuram, Kotdwar, Pithoragarh, Haldwani, and Almora

The Women Welfare and Rehabilitation Centre at Almora

About Nari Niketan Almora, Uttarakhand The Government Women Welfare and Rehabilitation Centre at Almora formerly called Nari Niketan Almora was originally established in 1970 in Almora as a facility to serve underage girls or adult women who were survivors of sexual abuse. This original facility was housed in a rented building located only few kilometers away. The current facility was built in 2002 and is a government owned building. The institution also has an optional outlet for women to get married and leave the institution to start fresh with new family on their own will if they want to get married and get a proposal by someone from outside. The institution is designed to house up to 21 people, but there are currently only 13 women residing there. Total rooms are 7 in number, each room with 3 beds. The other rooms include Craft Room, Ration storeroom, Teacher’s room, staff toilets, Special room, Nurse room, Main Hall area, one miscellaneous room and the office room. Currently the Institution serves adult women who were either found homeless, lost, or were abused and sent by the magistrate. There are two women who have speech and Hearing

Institutional Mapping Report: The Women Welfare and Rehabilitation Centres at Kedarpuram, Kotdwar, Pithoragarh, Haldwani, and Almora

impairment and one who has Visual Impairment. There are around two to three women who have mental health concerns while rest of them are under observation and currently does not have any illness or a disability (as per the medical data available). There have been no deaths in last 7 years in the institutions and in last 30 years, none of the residents have been married and moved away. The women living here comes from different age groups and background and cultures however maximum of these women belong to the Uttarakhand while few of them are from other states. The youngest woman in the Institution is around 20 years old while the oldest woman here currently is around 54 years old (as per the data available). There are 3 neighboring Institutions around Women Welfare and Rehabilitation Centre which have separate entry and exits and separate campus. We did not visit these institutions, but we were made aware of these by the superintendent. 1) Shishu Sadan (children) 2) Bal Kishori Grah (under 18 girls) 3) Samprekshan Grah There is total 10 staff assigned with the institutions currently. Some of them work in shifts.

Question 1: What do we know about the women living at Nari Niketan Almora? Understanding basic age data helps up see what sorts of services might be appropriate, and the levels of support which might be necessary in a long-term community support. This facility has only adult residents as it is surrounded by 3 other government facilities specifically designed to serve children and underage girls.

Number of Nari Niketan Almora Residents over 65 years:

Average age of adults:

39 years

(range 20-50)

Number of Nari Niketan Almora Residents under 18 years:

Institutional Mapping Report: The Women Welfare and Rehabilitation Centres at Kedarpuram, Kotdwar, Pithoragarh, Haldwani, and Almora

Living Situation Prior to Nari Niketan Almora

Nari Niketan Haldwani

23%

Unknown

31%

46% Family Home

The women came to this institution through three channels – six women from family homes (often abusive environments), three from the Nari Niketan in Haldwani, and four from unknown circumstances, but were found and brought to this institution. At least half were married in past or at present, and a number of these women have children outside the institution, as well as a great number of siblings.

THE AVERAGE LENGTH OF STAY FOR THE 13 RESIDENTS AT NARI NIKETAN ALMORA BY DATE OF ADMISSION IS 3.3 YEARS. ONE WOMAN HAS LIVED THERE FOR NEARLY TWO DECADES, AND IT APPEARS SHE WAS INSTITUTIONALIZED IN OTHER FACILITIES PRIOR TO THIS LONG STRETCH OF HER LIFE.

What Geographic Areas do they come from? It is important to note that just because a woman is in this Uttarakhand institution, it does not mean this is their home community or home state. However, the majority of these women appear to both consider Uttarakhand their home, and have lived within the state for their lifetime to date.

Institutional Mapping Report: The Women Welfare and Rehabilitation Centres at Kedarpuram, Kotdwar, Pithoragarh, Haldwani, and Almora

Probable Home States of the 13 Women at Almora

Home State

Uttarakhand

Maharashtra

Chhattisgarh

Number of Women

Educational Status Educational Attainment of the 13 Almora Residents Senior Secondary (up to 12th class)

Up the 10th class

Secondary (up to 8th class)

Primary 1st-5th class

No Education

Unknown

1 0

Number of Women

The chart above shows the actual number of people who have participated in education, ranging from class 1 through class 12. It should be noted that attendance does not mean matriculation or pass. The majority of the women at Almora have no education, but four of the women discussed their work experience in cattle rearing, working in an Anganwadi as a helper, day labor, and making and selling handbags.

Question 2: How much support do the women need? Communication Skills Looking across the population of the institution, 11 of the 13 women at the institution communicate effectively using speech, no matter what language they primarily use, which will be explored later.

Institutional Mapping Report: The Women Welfare and Rehabilitation Centres at Kedarpuram, Kotdwar, Pithoragarh, Haldwani, and Almora

Of the three women we explored this topic with, primary languages were identified for each of the women as follows: Primary Languages Spoken or Understood by the 13 Women at Almora Number of Persons

6 5 4 3 2 1 0

Hindi (primary)

Gesture (primary)

Garhwali (primary)

Bhojpuri (primary)

Marathi (primary)

Local Unidentified Language (primary)

Kumaoni (primary)

Primary Language

Communication is key both for reunification, as well as establishing trust, developmental growth, and assessing options. It should be noted that less than half of the women use or understand Hindi fluently, and this will be an important issue in reunification and also program support in any other type of community-based service. As for secondary languages, two of the women speak only a few Hindi words, three speak Kumaoni, another speaks some Urdu. The person who speaks Marathi and the unidentified local language have great difficulty in communication because others do not know their language. Three women have communication challenges due to disability, and they either do not speak using words, or have speech which is very difficult for others to understand. Augmentative communication will be important in planning for community life.

Independence in Everyday Life Skills In order to determine the amount of support each person would need to live outside the institution, it is important to assess the assistance which would be required in many daily living skills. For this process, we selected level of independence in bathing, dressing, menstrual care, eating, personal grooming, and toilet use. The women living in the Almora facility are independent in virtually all areas of personal care. This paints a very different picture of support needs than at the Nari Niketan Kedarpuram facility.

Institutional Mapping Report: The Women Welfare and Rehabilitation Centres at Kedarpuram, Kotdwar, Pithoragarh, Haldwani, and Almora

Independence Level in Activities of Daily Living for Women in Almora Nari Niketan Using toilet

100

Care of personal belongings

100

Menstrual care

100

Grooming and brushing

100

Care of bedding

Eating

100

Dressing

100

Bathing

100

Cooking preparation

100

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Percentage of Independent

100% of the adults at the Almora Facility ambulate independently, and are fully able to go up and down stairs, and navigate rough terrain safely. There are no mobility support needs.

Question 3: Diagnostics, Labels, and Medications Three women carry the label of developmental disability, one with an accompanying speech disorder. Two of the women are characterized as having mild impact of intellectual disability, while a third person has a moderate level of impact of intellectual disability. Although only two individuals are officially labelled as having a mental health diagnosis (schizophrenia), 5 are taking anti-psychotic medications. The staff or records described the three women prescribed psychoactive medications without a diagnosis as showing symptoms such as muttering or self-talk, or psychosis.

Institutional Mapping Report: The Women Welfare and Rehabilitation Centres at Kedarpuram, Kotdwar, Pithoragarh, Haldwani, and Almora

Conditions and Medications of the 13 Women at Almora 100% 80% 60% 38% (5) 40% 23% (3) 20%

15% (2)

20% (2)

8% (1)

0% Psychiatric diagnosis (official)

Diagnosis of Taking medications developmental for general health disability (mild/moderate)

Taking psychiatric medication

Seizure Disorder

Families have been in contact with facility

31 0

Family reunification seems possible and likely Family reunification seems unlikely and impossible

Family contact information unavailable

46 0%

20%

40%

60%

80%

100%

Although the contact information for nearly half the families is not available, and several families who are in contact refused the return of their family members, there is still open possibilities for reunification. For example, two family members replied that they have health problems or are otherwise unable to support their family member at home. However, reapproaching them and developing a family support plan could change this scenario. Building trust by discussing remembrances in each person’s first language could also yield important information as to the location of their families.

Institutional Mapping Report: The Women Welfare and Rehabilitation Centres at Kedarpuram, Kotdwar, Pithoragarh, Haldwani, and Almora

Question 5: Citizenship and Benefits Personhood and identity is defined in some ways by holding official identity in the eyes of the people, the community, and the state. Aadhaar card is the necessary identification one must hold in order to avail any community resources outside the institution. As well, voter ID card and disability certificate are keys to both participating in civic life as well as gaining access to essential rightful benefits available to people with disabilities in India. The following table indicates the percentages of women who hold such benefits, and this institution has a much higher rate of disability certificates, with nearly half the women holding it. As a result, four of the women earn a disability pension of 1200 INR each month, and they each have a bank account. Another woman has applied for her Aadhaar card. Identification Cards Applied for or held by the Women at Almora 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

31 8 0

Aadhaar Card

Voter Card

Disability Card applied for

Disability Card holder

Bank Account holder

Question 6: A Snapshot of Exit Paths We have the unique ability to have a closer look at the particulars of 41 women who were at Nari Niketan from 2015 onwards, but were discharged from the facility over the course of the next 8 years. Again, this important information offers us a window to show where people went when they left the facility. Exit Paths for Cohort of 39 People 2015 - Present We did not have discharge information for two of the women, so only 39 persons show on this graph. The two “exit pathways” for these 39 women are as follows:

To Institution, 9 Persons

23%

These are the highest reunification rates of any of the 5 facilities across Uttarakhand, but again there was no way to verify if any of

To own Recognizance, 1 Person

Institutional Mapping Report: The Women Welfare and Rehabilitation Centres at Kedarpuram, Kotdwar, Pithoragarh, Haldwani, and Almora

74%

To Family Home, 29 Persons

these reunifications have lasted over time, or if the women were later re-institutionalized anywhere. As for the people transferred to other institutions, the following are the facilities:

Women Welfare Home Nari Niketan Dehradun:

Bageshwar Old Age Home:

Rajkiya Bal Kishori Grah:

SOS Bhimtal: (she is reputed to be employed there now)

Nirashrit Mahila Karmshala (One Stop Centre):

This data reveals the dire need to follow-up with families, making sure that a support package in in place, and track well-being of the women over the long term.

Institutional Mapping Report: The Women Welfare and Rehabilitation Centres at Kedarpuram, Kotdwar, Pithoragarh, Haldwani, and Almora

So, What does all this Mean? This information yields solid ground to envision a way forward that makes sense. We offer an initial set of 10 pathways forward as follows.

1. Create and Utilize Exit Pathways from the 5 Nari Niketan Facilities 1a. Establish family-based services for children institutionalized at Balika Niketan, including those with disabilities Balika Niketan, the children’s shelter home directly next door to the Women Welfare Rehabilitation Centre in Kedarpuram is a major entry route for Nari Niketan Kedarpuram. In fact, it functions as a sorting place. As children with disability are identified, they tend to be shifted next door to the Nari Niketan. This is a very difficult, even devastating situation for these children. Supportive family foster care and adoption should be available for these children, as they already are in part to the typical children institutionalized. From our finding, some children are diverted into local NGOs like Raphael Ryder school, which is a much “less-worse” scenario. However, we believe that all children belong with families, and that includes people with disabilities. Well-supervised, well-supported foster home situations are much better than institutional settings. Specialized education must also be made available to any and all children at Nari Niketan, in regular (preferred and in line with Right to Education Law) or special schools, or in home with tutors.

1b. More Family Reunifications are Possible Family reunification, as modeled by Unity Uttarakhand is thus far looking promising for the people who are experiencing longer-term institutionalization or complex family situations. In the last two years 15 reunifications per year have been made by Nari Niketan, Dehradun, and within a year, we will be able to compare the longevity of these reunifications to those we have captured in this report. Because there is no long follow-up after reunification, we literally have no idea of the outcomes of almost any of the cases, except at the Dehradun facility, where the outcomes could be improved. Based on our reunification rate in the past 2 years, we estimate that perhaps 12 persons can be reunified each year, in addition to the quick reunifications that the government staff manages.

1c. Reserve the more difficult reunifications for Specialist Programs Government staff, especially at Haldwani, are often able to reunify lost family members quicky, within days, and these types of reunifications do not require the

Institutional Mapping Report: The Women Welfare and Rehabilitation Centres at Kedarpuram, Kotdwar, Pithoragarh, Haldwani, and Almora

time, effort and planning required. For those situations where lengthy trust-building, detective work, relationship building with families, support packages, and intensive follow-up are needed, utilize Unity Uttarakhand’s family specialist reunification, operated by Keystone in close collaboration with government.

2. Prevent Admission to Institutions 2a. Establish a Diversion Program Once a person is admitted to one of the Nari Niketan facilities in Uttarakhand, the process of extricating them is difficult, due to court orders and entangled bureaucracy. According to staff at Nari Niketan Dehradun, many women begin the process of admission in the local hospital (Doon Hospital). Facilitation of reunification will overall be easier and more effective if a referral is made when it appears that a person may be sent to Nari Niketan. This will give a fighting chance to avoid institutionalization. The possibility of a temporary respite for stabilization and family reunification to avoid placement in the institution has great risks but should be examined. We recommend that a Prevention Desk is established to be notified as soon as there is news of an impending admission. The Prevention Desk will initiate an immediate plan to meet with families, develop a support plan, and stabilize the situation. Even if institutionalization is unavoidable, the supportive relationship with the family will be a benefit to get the family back together as soon as it is possible and safe. This strategy prevents new admissions coming into Nari Niketan while also working in creating robust families and communities.

2b. Strengthen families of persons with disabilities within their own community through One Stop Centre’s across Uttarakhand It has been observed that families, for the most part, would like to have their family member with disabilities stay with them. However, they often lack the resources, know-how, and support to make this possible. To help allay this, we need to strengthen the One Stop Centres to survey, support and strengthen families having persons with disabilities to prevent separation in the first place. We propose a training and development program to sensitize the staff to the harm of institutionalization when there may be other alternatives.

3. Create Exit Pathways for Current Institutionalized Women 3a. Establish a Supported Living service model for those women who need minimal to moderate assistance The information we gathered includes the simple fact that about half the women need only intermittent daily support. With attention focused on transition back to community, small scale residences akin to the Home Again program replicated and widely used in some states would be an alternative that makes sense.

Institutional Mapping Report: The Women Welfare and Rehabilitation Centres at Kedarpuram, Kotdwar, Pithoragarh, Haldwani, and Almora

Assistance with livelihoods, personal safety, and mental health support including medication monitoring and health oversight will be necessary. We term this service model Supported Living, and it can be defined as modest homes and flats in decent areas where the women live in small groupings. They work together to run their household, and have daily support available, but not always on site over time. Staff serve as advisors and mentors, and crisis prevention is provided in a proactive manner. This Supported Living arrangement is being piloted by the Government of Uttarakhand in 2023, and we believe the model will be an excellent alternative to long term institutionalization. It is estimated that 8 women per year of the women within all five institutions would adapt well in a Supported Living setup.

3b. Prioritize women with children living with them in the institution Two of the institutions house women with children within the adult wards, two of whom are babies. We recommend that these women and their children be prioritized for high-intensity family reunification efforts, and if this is not successful, then Supported Living arrangements be pursued if appropriate. Longterm institutional stay will likely result in the children being removed from their mother, institutionalized in a children’s home, and even adopted out. We believe strengthening these fragile families is a priority.

3c. Replicate “Community Lives” homes for people with more significant Support Needs There remain approximately 30 people with developmental and physical disabilities mostly at Nari Niketan Dehradun who will need lifelong and constant care and support either due to the impact of disability or infirmities due to age and medical status. They also deserve and should be included in a community life. All their services can and should be provided in regular homes in the community, including personal care, developmental activities, livelihood development, and healthcare services. Community Lives in Herbertpur serves as a model for this type of support. It is costly, there are drawbacks, but creating supportive housing which is a real home with supports in place is one of several important exit paths that will need to be expanded. We recommend that such programs be created, with no more than 4 -5 persons living together to serve this population.

3d. Establish Family Living Programs/Specialized Foster Care for Adults We recommend exploration and piloting of the recruitment and matching of families who agree to open up their homes to a carefully matched individual with a developmental disability. Support, supervision, and financial compensation is provided. This model has been effective in many places internationally, including in less affluent countries. There has been initial interest from the Government of Uttarakhand in allowing a pilot of such a program, and that will be piloted in 2024.

Institutional Mapping Report: The Women Welfare and Rehabilitation Centres at Kedarpuram, Kotdwar, Pithoragarh, Haldwani, and Almora

4. Other Recommendations: Improving Institutional Life 4a. Focus investment in community services rather than institutional facilities It is apparent that significant investment in bringing the Dehradun facility up to basic standards has happened, and there is no end to the improvements that can be made. We caution that a focus on investment in facilities such as this may and will pre-empt efforts to create a community system of support where, at the very least, institutionalization is very truly a last resort. We recommend that no investment be made in expanding the size of the existing institutions, as this promotes the institutionalization of more people when community services are preferable in every way we can measure. Instead, resources could be redirected to community-based programs such as the ones described in this document.

4b. Stack the Deck for a Successful Community Life of Citizenship Gaining Aadhaar cards and, if relevant, disability certificates and disability identity cards NOW, rather than later, will yield benefits for both family reunification as well as other ways that may open for people to leave the institution. The card can equate to a monthly pension which allows the person to have a basic living stipend, a boon to families which are on the edge. This is not an easy task for anyone, may take a long time to gain, but is important. Aadhaar cards are important as well and are impossible to get without a verifiable address. This will add up to two less stumbling blocks which tie up family reunification and keep them poor and desperate. We can see that some facilities that we mapped have prioritized this, and the results are clear. The Dehradun and Almora facilities have focused on this, and it demonstrates that progress is possible. Several women we met over the course of our mapping have their own bank accounts. Others need to be assisted to have their own accounts. Active and concerted assistance to the women in obtaining a disability pension will help them to have some savings in their own bank accounts which they can use when they are reunified with their families. It also gives them some seed money to start an enterprise or contribute towards the family income post- reunification.

4c. Launch a Community Connections Program Community interaction is important for everyone. For women in Nari Niketan’s in Almora, Pithoragarh, Haldwani, Kotdwar and Kedarpuram, life is limited to the four walls of the institution. However, recruiting individual upstanding citizens who live in the local area to be matched with one institutionalized woman to visit on a regular basis would encourage the women and give them a view of life beyond the four walls of the institution. This would also help build community supports for each woman, enrich community members, and create goodwill.

Institutional Mapping Report: The Women Welfare and Rehabilitation Centres at Kedarpuram, Kotdwar, Pithoragarh, Haldwani, and Almora

4d. A voice within the premises of the institutional facilities Women staying within the premises of the 5 institutional facilities have little voice or choice in decisions that affect their lives. While we are aware that some decisions need to be taken by the administration, the women also need to be given some choices over issues that affect them. An advocacy team, comprising of a few women living within Nari Niketan, could be a voice for every woman within the premises. It is therefore recommended to form an advocacy council who could meet with the administration frequently to place the issues faced by the women.

Institutional Mapping Report: The Women Welfare and Rehabilitation Centres at Kedarpuram, Kotdwar, Pithoragarh, Haldwani, and Almora

Final Words The remaining long-stay institutions for people with disabilities will be increasingly replaced by community services. Uttarakhand remains an excellent proving ground where different service types decrease the need for such facilities, due to its size, its engaged and willing government, and the excellent first efforts that have been successful, such as Community Lives and Unity Uttarakhand. Other institutions in other districts have already asked for Family Reunification efforts such as are being launched in Dehradun, and momentum is high for change. If it is true that the welfare of all of us is vested in the welfare of each one of us, then it is high time we attend closely to the plight of institutionalized people with disability and create pathways towards dignified lives, meaningful livelihoods, and full participation as Indian citizens. We thank all the partners who opened the door to this look at the lives of well over a hundred women and girls who remain hidden away from much of society. They are worth our time, our efforts, and our advocacy to create better possibilities for citizens with disability, in Uttarakhand and beyond.

Institutional Mapping Report: The Women Welfare and Rehabilitation Centres at Kedarpuram, Kotdwar, Pithoragarh, Haldwani, and Almora

References Girls with Psychosocial or Intellectual Disabilities in Institutions in India. (2014). Human Rights Watch. https://www.hrw.org/report/2014/12/03/treated-worse-animals/abuses-against-women-and-girlspsychosocial-or-intellectual National Strategy for Inclusive and Community Based Living for Persons with Mental Health Issues. (2019). The Hans Foundation. https://thehansfoundation.org/wp-content/uploads/2020/07/THFNational-Mental-Health-Report-Final.pdf

Institutional Mapping Report: The Women Welfare and Rehabilitation Centres at Kedarpuram, Kotdwar, Pithoragarh, Haldwani, and Almora

Notes