The type, quality, and quantity of psychological support can have a significant, positive impact on those living and working in extreme environments. Using the programs in the National Aeronautics and Space Administration (NASA) and the Canadian Space Agency (CSA) as examples, the authors describe the range of psychological support offered to the astronauts and their families. The chapter begins with a review of how and why psychological support has evolved over the decades, followed by details about the current operating model. The chapter concludes with a look at how the types of support offered and the mechanisms available for providing that support will necessarily change as NASA and its international partners look to venture beyond the low Earth orbit of the International Space Station.