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Australian & New Zealand Journal of Psychiatry, 55(2) Progress in psychiatry may be looked for in three domains: scientific knowledge, clinical services and health outcomes. The writer has now seen Psychiatry for 60 years, providing an opportunity to consider what may have advanced. That task has been astutely proposed by the Editor. What follows is inevitably a highly selective account but one that nevertheless counts because of its time span.

Australian & New Zealand Journal of Psychiatry, 54(10) In the ANZJP, and other similar scientific journals of merit, submitted manuscripts are routinely sent to two or more respected individuals for their anonymous assessment. Being invited in this manner to act as a peer reviewer for the journal is a badge of honour. It means that you have been selected by ‘those in the know’ to offer your opinion because they recognise you as an expert. In other words, your view matters and carries weight. Although the process is anonymous, it is normative for reviewers to include in their track records and CVs their role as a reviewer for particular journals, with kudos associated with being invited to review papers especially for the most prestigious journals. All in all, being asked to review papers means that one is held in high regard by one’s peers. However, in recent years in particular, it has become increasingly difficult to persuade qualified people to undertake reviews. In the ANZJP, reviewers for submitted manuscripts are sought from Australia, New Zealand and overseas. These reviewers are chosen by the Editors because they are considered experts in the subject matter or, alternatively, because they work in an overlapping field, have no special investment in the topic but have general expertise, good sense and a critical eye. Authors can suggest who might be approached or avoided – however, these recommendations are not binding and editors will often make selections of their own. In some journals, reviewers are blind to the identity of the authors. However, in many other journals, including our own, the reviewer is shown the identity of the authors. Realistically, reviewers can never be wholly free of bias in either direction, but there is an expectation that they conduct themselves ethically. For example, upon receipt of an invitation to assess a paper, the reviewer must alert the journal if they feel they have a conflict of interest and cannot conduct the review because of this concern. Often there is no reasonable way for the editor to know whether, for instance, the reviewer and author have a joint research grant, are personally related or were best friends at school. Furthermore, the reviewer must not contact the author regarding their manuscript without the Editor’s permission, nor should they inform any third party about the content of the manuscript and its authorship, or subsequently reveal that they were asked to assess it. This is accepted etiquette. To carefully read and critique a manuscript can take anywhere from 20 to 30 minutes to 2–3 hours, depending on the kind of article that is being assessed (e.g. letter, commentary, original research, systematic review). For a research article, a good reviewer will comment on the importance of the research question being addressed, the originality of the study, the adequacy of the methodology including statistical analysis, whether the author’s interpretation is justified by the data, clarity of writing and any relevant ethical issues (Garmel, 2010). In the ANZJP, there is Finding reviewers: A crisis for journals and their authors

Australian & New Zealand Journal of Psychiatry, 51(2) The growth in Australasian academic psychiatry is truly wonderful. When I joined Leslie Kiloh in Sydney in 1963, there were five Professors of Psychiatry in Australia and one in New Zealand. In earlier times, academic psychiatry had been ahead of Britain, in that both Sydney and Adelaide had made Psychological Medicine compulsory in the medical curriculum by 1888, while Sydney had appointed a Professor by 1922. What follows applies only to academic psychiatry during the last 50 years, not to the massive expansion in state mental health services, a multidisciplinary workforce and private practice. David Maddison, then the only Australianborn professor, was at Sydney University, Leslie Kiloh had just arrived at University of New South Wales (UNSW), Bill Cramond had been appointed at Adelaide, FA Whitlock had come to Brisbane and Brian Davies had arrived in Melbourne. Wallace Ironside had been appointed Professor in Dunedin in 1962. Our other medical schools either had no chairs of psychiatry or were not yet established. Psychoanalysis was prominent, especially in Melbourne, and psychodynamic expressions were de rigueur in professional conversation. There was little research activity and no focussed programmes. Cade’s finding on lithium had just started to be applied, but mainly in Denmark and America. Now consider what academic psychiatry in our two countries has achieved some 50 years later. We now more than hold our own on the international stage, despite our small population. As I see it, we have excelled in five fields: instilling rigour in routine clinical practice; in epidemiology, notably through longitudinal population studies in both our countries; the burgeoning field of neuroscience; excellence in treatment of the psychoses and the affective disorders; and health services research. The wave of imported academics from overseas is now only a trickle. Incidentally, there was a period in the 1970s when five professors in Australasian psychiatry had come, either by birth or their previous job, from just one source, Aberdeen: Cecil Kidd in Perth, Bill Cramond in Adelaide, Wallace Ironside in Dunedin then Monash, Leslie Kiloh in Sydney and myself in Hobart. I cannot offer a rational explanation for that p-value. As in medicine and surgery, our younger graduates no longer need to go to the United States or United Kingdom for advanced training. Instead, because travel is much easier, they now have invaluable exposure to research at international symposia, often leading to lasting alliances with other investigators. Research from our two countries now commands great respect, and sometimes envy, in the rest of the world. Consider the authorship of papers in any of the leading international journals, or the input of Australian and New Zealand psychiatrists at elite international research societies and their symposia, or invitations from major overseas institutions to give expert advice, on site. What greatly interests me is how this exceptional development has come about. I can think of six factors. First, it took place when psychiatry across the world was starting to take its proper place in medicine generally and to have a place in the undergraduate medical curriculum. Second, Australian and New Zealand medical schools were seen as highly attractive places for many British academics. Third, both countries have for long had their share of exceptional young minds with the capacity to think innovatively. These young graduates now stay on here. A few have chosen research in psychiatry because of the unique scientific and clinical opportunities it offers. But more should be invested in this precious group, lest their numbers decline (vide infra). In my own view, we need a much better research career structure for promising young physicians. As it stands, National Health and Medical Research Council (NHMRC) and Health Research Council (HRC) grants go only to those who are already established and often not even then. I say this as one exceptionally fortunate individual whom our NHMRC supported for 26 years with a small team, albeit untenured and for only 5 years at a time, but in full-time research. How many psychiatrists do our Councils currently support under such Retrospective: Australian and New Zealand psychiatry: What 50 years have brought