This chapter considers how psychologists’ work has changed and evolved, important issues related to this work, and future directions suggested by current trends. Aspects of transformation and important issues that are identified include: the commonality of issues and trends across facilities and geographical boundaries; current inpatient psychology work’s grounding in the past; development and adaptation of assessment and treatment models to meet current needs; the expansion of psychologists’ work and roles; innovative approaches to treatment; efforts to establish and promote the effectiveness of specific treatment models; consequences of policies such as deinstitutionalization and treatment trends such as the Recovery model; psychologists’ interactions with colleagues within treatment teams; staff hierarchies; the predominance of medically driven treatment; new treatment directions; support of trainees; and the value and impact of psychologists work in such settings. Relevant chapters in the current volume are cited pertaining to each issue.