Poverty alleviation for people with severe mental health conditions in South Africa: A qualitative study.

People with severe mental health conditions (SMHC) and caregivers in South Africa often experience poverty. The PRIZE trial found that recovery groups were acceptable, feasible and potentially effective in reducing relapse. Addressing economic needs was identified as a means to increase impact. This study aimed to understand the acceptability of poverty alleviation interventions as an adjunct to psychosocial interventions.We conducted two focus group discussions and 12 in-depth interviews with 14 people with SMHC and 13 caregivers in Eastern Cape Province, South Africa. An inductive thematic analysis was conducted. We identified four themes. 1: Financial insecurity as a defining influence on life. Participants perceived financial security as crucial to recovery. However, financial insecurity was entrenched due to violence in neighbourhoods and fractured communities.2: Government disability grants are not a panacea. There were difficulties accessing disability grants. Whilst welcomed, they sometimes caused problems such as family disagreements about how the money was spent.3: Group savings offer tentative hope if carefully managed. Several caregivers had experiences of community-based credit unions. However, some were fearful of members absconding with funds. Participants emphasised that trust, safety and fairness are essential for successful group savings. 4: Income-generating activities are desired but need capital and come with safety concerns. Many had ideas and motivation for small businesses but needed financial capital. There were concerns that gaining wealth could make one a target of crime. Poverty alleviation interventions could positively impact the wellbeing of people with SMHC in South Africa as an adjunct to psychosocial interventions and psychiatric care. Approaches could include supporting access to social protection or existing savings groups, and nesting new savings groups or income generation initiatives into psychosocial interventions. Any model would need to incorporate mechanisms to ensure participants' safety and would be enhanced by public health interventions to build social capital and reduce violence.