Depression and anxiety disorders are very common in the elderly. Data accumulated over the past 2 decades have shown that most older patients can tolerate and respond to acute treatment with serotonergic antidepressants, other psychotropic agents, or manual-based psychotherapy. However, outcomes under usual-care conditions remain poor. This review proposes that clinicians may significantly improve the long-term outcomes of their older patients with depression and anxiety by focusing on four key factors: (1) identification and treatment of comorbid conditions; (2) full remission of acute symptoms; (3) education of patients, families, and professional colleagues about the need for long-term treatment; and (4) prevention and management of medication side-effects.

Underdiagnosis and undertreatment of late-life depression is common, especially in primary care settings. To help assess whether physicians' attitude and confidence in diagnosing and managing depression serve as barriers to care, a total of 176 physicians employed in 18 primary care groups were administered surveys to assess attitudes towards diagnosis, treatment, and management of depression in elderly patients, (individuals over 65 years of age). Logistic regression was performed to assess the association of physician characteristics on attitudes. Nearly all of the physicians surveyed felt that depression in the elderly was a primary care problem, and 41% reported late-life depression as the most common problem seen in older patients. Physicians were confident in their ability to diagnose and manage depression, yet 45% had no medical education on depression in the previous three years. Physicians' confidence in their ability to diagnose, treat, and manage depression, and their reported adequacy of training, do not appear to correspond to the amount of continuing medical education in depression, suggesting that physician overconfidence may potentially be serving as a barrier to care.

For more than 50 years the United States and Canada maintained illegal-drug policies that followed the same course: a long period of punitive prohibition followed by moderation and an emphasis on drug abuse as a public health problem. Then in the 1980s, the USA reverted to a punitive model while Canada increased its commitment to a health-based approach. Why this divergence after following the same path for so long? In this paper I argue that one factor was Canada's adoption of national health insurance, which guaranteed universal access to health care, including addiction treatment. As the country's most popular policy it was protected against budget cuts during a period of welfare-state retrenchment in the 1980s. In the USA, on the other hand, public health insurance was limited to the elderly and the poor, and addiction treatment services were isolated and stigmatized. Thus the public health side of drug policy was poorly positioned to resist welfare cutbacks and ascendant criminal-justice interests. The experiences of the USA and Canada have implications for policy reformers and for the study of how institutional interests cross policy domains.

When people think of the origins of American social policy, they usually think of the 1935 Social Security Act, part of Franklin D. Roosevelt's second New Deal. That legislation created both old-age insurance, now commonly known as social security, and Aid to Dependent Children (ADC), recently known as welfare. Though central to today's social policy, these programs were somewhat marginal to New Deal social policy because they dealt with special categories of “unemployable” citizens. The key concern of New Deal social policymakers was instead with those deemed “employable,” and their problems were addressed mainly by another and much less studied program from the second New Deal: the “Works Program” operated mainly by the Works Progress Administration (WPA). The lack of attention to the WPA has had important consequences for understandings of American social policy.