Mental Health Awareness Month; October 2024

by Prof T Lazarus on behalf of the PsySSA Division of Neuropsychology and Forensic Psychology.

Mental health is affected by multiple factors, both biological and socio-economic in nature. Communities from disparate social and economic backgrounds are not immune to mental health challenges, and this may occur across the lifespan. With respect to brain changes resulting from disease or trauma, the ensuing mental health changes encompass multiple domains of functioning, including cognitive, emotional, behavioural and social. Far-reaching consequences that extend beyond the patient, impacting personal, interpersonal, family and work activities are often evident. In the case of brain trauma, it is now recognized the injury to brain, even minor in nature, may impact education and work activities, and personal relationships.

The sequelae may be managed with various forms of interventions such as cognitive rehabilitation but persisting difficulties are found years beyond the post-acute recovery period. Apart from trauma, the impact of brain diseases such as stroke leaves residual problems not only in the physical domain (such as weakness of a limb or loss of speech), but in thinking and emotional functioning. More recently, research has suggested that the COVID virus does enter the brain, impacting various domains of functional capacity, leaving patients who had this infection with persisting problems of thinking (commonly referred to as ‘brain fog’) and emotional difficulties (more often depression and anxiety). Neuropsychologists are called upon to determine to what extent functional capacity is affected in long-term COVID conditions. Thus, long-term care is now commonplace for victims of brain injury and disease, with patients experiencing difficulty returning to employment and resuming relationships.

In addition to the clinical implications of brain disease, the potential impact of brain related disorders is becoming more evident in legal matters. Acting impulsively and displaying aggressive or violent behaviours, showing poor judgment in managing self-behaviours in public and private contexts, and the inability to manage one’s personal affairs is common in brain injury and/or disease. In these instances, neuropsychologists possess the training and skills to formally assess patients with brain disease or injury, providing recommendations in regard to individuals’ functional capacity to return to work, ability to manage their personal affairs such as financial matters, as well as investigating whether a brain injury impacted judgment in cases of violent behaviour or instances suggesting poor judgment or insight into their behaviour. With the increasing burden of disease and injury impacting the brain structurally and its functioning, neuropsychologists are well-placed to offer the South African community expertise in identifying brain dysfunction, make diagnoses and management, and offer pertinent opinion on the impact of brain injury and/or disease on behaviour in medicolegal and forensic settings.