Even as growing evidence emerged on the links between physical and mental health and social disadvantage, Keshav Desiraju recognised poverty, deprivation and poorer social networks as predictors for poorer health and mental health outcomes. Therefore it wasn’t a surprise that as architect of India’s Mental Health Policy and Mental Health Care Act, he emphasised mental health care as a basic right for every citizen, placing the onus on the State to find both funding and developing a road map to ensure appropriateness and accessibility of care. This was his biggest win!
Mental health care was no longer exclusively within the ambit of health care but was part of the broader development discourse and linked to how people lived, and to corresponding values of equity, dignity, universality and person-centredness. Keshav was a visionary not just in that he made landscape level changes in how he placed mental health care at the centre stage within the health agenda, but also in that, perhaps for the first time, he outlined precipitating and perpetuating factors linked to structural barriers such as caste, class and gender-related disparities. He therefore recommended convergence between health and social sectors in developing robust responses.
Mental health was now also a social justice issue that in the absence of adequate care pathways churned out social crises ranging from higher mortality rates to homelessness and from rights violations to unemployment and segregation.
This paved the way for innumerable innovations that promoted community inclusion and addressed mental health concerns across one’s life span. Besides ensuring that the person living with a mental health challenge could access care in spaces that were therapeutic and responsive and placing the needs of the person first, balancing care with rights and the pursuit of capabilities, the focus was always on participation and agency, key tenets of the recovery process. Further, innovations such as basic income, out of work allowances, family support structures and outreach services on the streets were entering mainstream mental health conversations. Gradually mental health and well-being also found their way into the sustainable development goals and rightfully so. It is our belief that Keshav and his ilk contributed significantly towards this.
While advised by 10 members in drafting the Policy (including the first author), and by scientific evidence and ongoing practices in the mental health sector, he would always in parallel want to get a feel of what the real and messy world looked like. This was his most endearing quality both as a bureaucrat and policymaker. He would travel widely to hospitals, homes of impoverished persons, and always remain connected to those who may never have found their way into his life. We could see that he felt their suffering and in a sense that strengthened his sense of urgency to better understand issues and learn from people’s wisdom.
There was no difference between an Ivy League contributor or an experiential expert’s insights since his brilliant mind saw the need for and importance of both. This grounding, respect and capability to listen to people whom he believed he ‘served’ made him one of our finest officers and a rare breed. In this is a tip for budding bureaucrats in a changing culture; to hold close to one’s heart, values of humility, integrity and a sense of conscientiousness and purpose.
Post retirement he continued to work with civil society organisations to build organisational stability, good governance structures, value-based care approaches with focus on the advancement of the vision of equitable access to health in fields ranging from cancer care to mental health, women’s health to disability, palliative care to framing better health systems.
A man committed to completing a task on hand, small or large, he ensured that the Policy and Act were seen through to their completion and how! Similarly, even a few hours before he passed, while the paramedics were by his side, he sent out mails to cancel appointments indicating that he would get back to those individuals/ institutions once he returned from the hospital. This same sense of determined commitment to serve his fellow citizens and ensure that those relegated to the margins on account of their disability, distress or social vulnerabilities would experience a better future inspired him in all that he did, and he strived to do his best with quiet and understated elegance.
To honour his memory and celebrate his life, he would have liked many things to happen, and top on that list would have been the need for young Indians and budding public servants to pursue just one goal ardently — the need to work towards an equal, secular, inclusive, just and caring country. Better health and quality of life outcomes would be natural by-products.
(Vandana Gopikumar is co-founder, The Banyan and The Banyan Academy, and Ravi Chellam is a wildlife biologist and CEO of Metastring Foundation)