There have been dramatic changes to municipal services such as water and electricity since the end of apartheid in South Africa, with considerable research having gone into the impacts of commercialization and cost recovery on low-income households. The research has revealed a complex and often negative relationship between the marketization of these services and access and affordability for the poor. It has also been shown to have direct and very negative public health implications, most acutely in low-income township and rural areas. Less obvious, and much less researched, have been the impacts of changes in service delivery on the mental health of low-income residents and household members. The fact that there is a relationship between poor mental health and poverty in general has now been well established. What, then, might be the links between poverty, mental health and the shift towards market-oriented reforms in basic services? This paper explores the relationship in the South African context with a detailed, ethnographic case study of 10 low-income families in Cape Town coping with a serious mental disorder (schizophrenia). While the study is too small and too preliminary to lead to firm conclusions about service delivery and mental disorders in general, the outcomes do point to issues that bear further consideration and discussion and are presented in the paper: • Health and safety problems • Time and energy • Social tensions • Social activities • Relapse • Impact on caregiving environment All of the households interviewed experienced considerable financial hardship as a result of cost recovery strategies on basic services, with 29% of household income being spent on water and electricity on average, and arrears on water and electricity bills as high as R18,200. Respondents expressed anxiety about this situation, noting that it added considerably to overall family stress. A range of strategies were used by these households to minimize water usage, with the need to save water becoming a further source of anxiety and conflict. Similarly, concerns were raised about electricity usage and cut-offs, with disability grants being used to pay for fuel and basic services in many households. Respondents did not necessarily draw direct links between experiences of service delivery difficulties and the onset or relapse of mental disorder, but it is clear that uncertainty about services in the context of poverty add to overall stress levels. In summary, much remains to be done in terms of realizing the rights of people with mental disorders (and their families) in South Africa. Without considering the broader context of poverty and service delivery it will not be possible for them to adequately improve their lives.
MSP Occasional Paper No.12