A variety of alternative programs are being implemented in Canada and the United States for students who have exhibited conduct problems and who are suspended or expelled from their schools. Given the complexity of issues that these students frequently face, treatment must be multifaceted, wrap-around, delivered by trained professionals and be targeted to these students' unique biopsychosocial needs. This article reviews the literature on delivery of mental health services within the broader school-based context. Specific mental health issues endemic in the high-risk adolescent demographic are highlighted, and implications for mental health professionals, particularly psychologists, working with such individuals are discussed. Suggestions are made with respect to screening and assessment instruments and treatment.