This year the journal has been celebrating 50 years of publication. The first 11 issues examined key developments in the creation and delivery of mental health services over the past five decades, with reprinted articles from the journal's archives and commentaries on these historical changes by contemporary psychiatrists. This final anniversary issue looks to the future—what is there to hope for and to be concerned about in the next 50 years? Leona Bachrach, Ph.D., whose work on behalf of the chronically mentally ill has spanned several decades, shares her perspectives in an interview with John A. Talbott, M.D. Dr. Bachrach says she is especially hopeful about the young psychiatrists who are entering the public-sector field with an idealism she has not seen for a few decades (page 1511). In a roundtable discussion, seven psychiatrists discuss future treatment breakthroughs, changes in settings of care, troubling economic forces, and other issues. A recurrent theme is better outcomes for patients (page 1513). In Taking Issue, Darrell G. Kirch, M.D., challenges mental health professionals to be willing to change their attitudes and their practices over the next 50 years in order to build psychiatric services that will last (page 1477).