As we enter the waning years of the 20th century, there is the opportunity to look to the future and also back to thank those who have contributed over the last year.
The next few years cannot be viewed other than in a context of concern and uncertainty. The overall climate of economics in North America is one of constriction in areas of help for those less fortunate by reason of misfortune, including illness. Reduction, downsizing, and radical eliminations are the calls for the times. Some, it is true, are overdue, if they lead to doing the same more efficiently. But now, after several years, reductions are fundamentally changing and interfering with essentials, rather than trimming the frills.
Psychiatry, as well as all of medicine, is vitally affected in both Canada and the US. While the systems are radically different, the end results are the same. In the US, managed care intrudes everywhere, and coverage is determined according to actuarial rather than medical reasons. In Canada, the single payer system is flexing its muscles and is increasingly telling physicians where, how, and what they can practice with minimal or no input from the trained professionals. The public is much more informed about health and its issues and demands to be partner rather than consumer in the process. Research funding is being reduced at a time when the support of research from clinical earnings is also in a rapid decline. Even the funding from pharmaceutical firms is subject to the tightening economy. Yet, most encouragingly, basic biophysiological, imaging techniques, epidemiology and genetic research are moving rapidly ahead and improving both our understanding and our practice.
The issues of human resources are crucial to the vitality of professional development and advancement. From some sources comes the statement that there are too many psychiatrists. There is no proof of the validity of this statement. Movement of psychiatrists between provinces is under increasing restriction and off-shore recruitment under a virtual ban. The longer-term results can only be a parochialism of practice, and teaching, as the stimulation of different ideas from different training approaches, becomes lost.
In such times, however, there are opportunities, albeit forced, to appraise and change what is done and how resources are used. The development of clinical practice guidelines for major illness categories are such an advancement. The emphasis on Continuing Medical Education is a timely contribution, and one which the Journal will support this year with a series of solicited review articles on areas of practice. As well, advancing technology poses opportunities and challenges for effective and rapid communication. All merit examination, including the much touted 90s' development of the Internet. The computer is now an integral part of the culture and turbocharges the exchange of information.
Amid the concern, stress and uncertainty, there are also opportunities for turning at least some of the changes to the advantage of the field and those it serves.
The publication of any Journal is a combined effort of many individuals, and to them at this time must be accorded recognition and thanks. On behalf of both Dr Kingstone and myself, this must go to the Editorial Board and particularly the Assistant Editors for their valuable and responsive advice. Staff members at Head Office have been ungrudging in their support under the leadership of Alex Saunders, and particularly the Editorial Coordinator, Christy Bradnock Paddick. The Executive and the Board of the Canadian Psychiatric Association have been both morally and tangibly supportive. A final and most important thanks must go to those who have reviewed submissions, a task both essential and time consuming, falling as it does often on the most busy. Reviewers' rapid response allows more rapid appearance of accepted articles. Those contributing last year are gratefully acknowledged in the list on the following page.