The study compared 41 elementary schools with expanded school mental health (ESMH) programs with 41 schools without ESMH programs. This matched comparison was possible because in the 2002-2003 school year, approximately 50 percent of the nonspecialized elementary schools in Baltimore City (Maryland) included ESMH components. The ESMH network included schools in which mental health clinicians from a collaborating community mental health center worked in a school in addition to regular school personnel. In ESMH schools, one or more masters-level or doctoral-level clinicians provided services for 40 hours a week. The data analysis controlled for school-level variables traditionally associated with out-of-school suspension (OSS) rates in order to determine the impact of ESMH services on these rates. Correlational analyses found associations between OSS rates and several school-level demographic variables, including school attendance rate, percent of students in poverty, and percent of non-White students in the school. After controlling for these variables, however, stepwise linear regressions found no significant difference between ESMH and non-ESMH schools on OSS outcomes. The authors advise that targeted and well-executed strategies that address behaviors associated with suspensions would be a better strategy for achieving the desired outcome. Another strategy would be to develop alternatives to suspensions that would keep the offending student in school while providing interventions to remedy the disruptive behavior. 5 tables and 27 references