This paper introduces the concept of emotional distress as a means of measuring the direct experience of inadequate access to drinking water in a small town in Ethiopia under the UNICEF-Government of Ethiopia urban ONEWASH plus programme. The paper explores a new perspective on the relationship between water technologies, water services, household socio-economic characteristics (as predictors) and mental health in its broad definition. Results indicate that water-related emotional distress is predominantly associated with the ‘cost of water’ and the ‘size of household’. Quantity of water, reliability of the preferred source and accessibility were not significant predictors to emotional distress. Whether the household accessed a pipe into a compound or another improved source was not a significant predictor either. The safely managed target in the Sustainable Development Goal (SDG) 6.1 focuses on the affordability, accessibility and safety of water but does not explore the relation between cost and water-related emotional distress. This evidence offers a complementary approach to the ‘affordability of water services’ as it looks beyond the mere financial implications of water costs.