"It Is Left to Me and My God": Precarity, Responsibility, and Social Change in Family Care for People with Mental Illness in Ghana

It has been argued that family care contributes to better outcomes for severe mental illness in Africa, and family care is championed as an alternative to institutional treatment; however, poor households are experiencing increasing precarity under global economic changes, which can be exacerbated by chronic illness. This article draws on an ethnographic study in Ghana to explore how families negotiate the tension between the moral imperative to provide care and the challenges of daily life with severe mental illness. Changes in family life, household costs, and migration can threaten the ability to meet the needs of a severely ill relative and fulfill social ideals of solidarity and responsibility. Such challenges raise questions for the viability of community-based models of mental healthcare in low-resource settings.