Objective: Regardless of the outcome of current efforts at healthcare reform, the resources that academic health centers need--to provide care for increasingly complex patient populations, support clinical innovation, grow the clinical enterprise, and carry out their research and teaching missions--are in jeopardy. This article examines the value proposition for psychiatry. Method: The authors describe areas where academic departments of psychiatry have opportunities to help shape the future of academic health centers in a rapidly-changing healthcare environment and share their experience in leadership roles in academic psychiatry and in consulting to academic health center leaders. Results: Many academic health centers are reexamining both their mission and their use of available resources. Some are questioning their ability to sustain traditionally low-margin clinical specialties like internal medicine, pediatrics, and psychiatry, where, all too often, clinical revenues alone are insufficient to cover the full cost of caring for the patients they serve. Conclusion: Academic departments of psychiatry must continually demonstrate their value to the academic health centers' clinical and academic mission.