Medical school departments of psychiatry ("psychiatry departments"), defined as those academic departments directly overseen by Chairs of psychiatry at United States medical schools, are central organizations to the functioning of U.S. psychiatry. Psychiatry departments oversee the basic science training in behavioral sciences of all U.S. medical students, either in full or large measure. In addition to traditional courses in human development and psychopathology, many psychiatry departments play active roles in teaching topics as diverse as neuroscience, pharmacology, and doctor—patient skills such as interviewing. Psychiatry is one of six core clinical disciplines, including surgery, medicine, pediatrics, obstetrics-gynecology, in which clinical clerkships are mandated by the accrediting body for U.S. medical schools, the Liaison Committee on Medical Education (LCME); without a coherent and effective psychiatry program, the accreditation of a U.S. medical school may be put at risk. Core clinical clerkships in psychiatry are also mandated by most state licensing boards in the United States and are often required to be taken in hospitals that have psychiatry residency programs.

In addition to these critical roles in exposing all future U.S. physicians to the disorders of behavior, psychiatry departments oversee, either directly or through other affiliated hospitals, the specialty residency and fellowship training of the vast majority of U.S. psychiatrists. Psychiatry departments produce much new knowledge and research in psychiatry and are major contributors to medical school and academic medical center research portfolios. They have essential roles in collaboration with other medical school departments, industry, and the federal government, with the goal of translating these findings into clinical practice throughout U.S. medicine. Also, they play a significant role in the continuing education of psychiatrists, other physicians, and nonmedical mental health professionals.

Psychiatry departments play an essential role in clinical care, as well. They oversee the provision of care in most major academic medical centers in the United States, providing important inpatient, outpatient, and consultation services. As such, they are a critical bridge in the dissemination of knowledge about the close interaction of medical and psychiatric disorders to most U.S. house staff and attending faculty in other medical disciplines. This role has become more significant as the high frequency and cost of psychiatric illness in the United States has been increasingly recognized. Psychiatry departments also have similar major roles in Veterans Affairs hospitals and facilities of state departments of mental health. Psychiatry departments are among the essential entities for the long-term health of U.S. psychiatry.

Despite this impressive array of roles and the extraordinary accomplishments of the core research, training, and clinical missions, psychiatry departments suffer challenging economic and political circumstances in their medical school and teaching-hospital environments. Among these are limited financial margins; subsidies by other departments to accomplish core missions; and competition for resources, including capital, in resource-constrained environments. This special issue of Academic Psychiatry is dedicated to understanding the strategic challenges psychiatry departments face and the opportunities for creative leadership.

Medical school departments of psychiatry represent key institutions in U.S. psychiatry. Their research findings have international preeminence and major impact on the care that patients will receive worldwide. Through their training of psychiatric residents, fellows, and medical students, psychiatry departments affect the care of many patients who will never see a psychiatrist. Their clinical enterprises provide care for some of the most desperately ill—and the most abandoned and disenfranchised. Despite this record of accomplishment, many departments are in financially-challenging conditions. They have relationships in research, clinical, and public-sector environments that are unique among medical school departments, but are often not fully understood, nor are they a priority for institutional leadership.

In this special issue, we hope to explore in greater depth the specific challenges departments face in all of these domains and examples of successful strategies for departmental growth, as well as the qualities of leadership that are required for department chairs.

We are in a uniquely important period in the history of psychiatry. The most devastating and feared disorders are beginning to yield their secrets to basic and clinical scientists. What we learn about neuroscience and human behavior will have increasingly profound implications for all of clinical medicine, our views of human nature, doctor—patient relationships, and our culture as a whole. In this effort, as well as in the broader training and clinical domains, medical school departments of psychiatry have key roles to play. We should make sure that the success of these efforts is not impeded by a failure to be bold and thoughtful as we confront the challenges to psychiatry departments.

At the time of submission, the authors reported no competing interests.