Although universal school-wide support efforts are sufficient for most students, some children need more specialized and intensive supports. These supports are organized into programmatic structures such as alternative programs, special education, and Title programs. However, as Atkins, Graczyk, Frazier, and Abdul-Adil (2003) have described, an additional important need exists in schools to provide mental health services, especially for children and families in disadvantaged urban contexts. They also indicated that although the need is clear, current efforts give insufficient attention to contextual factors that limit access to services, reduce intervention effectiveness on "real-life functioning," and reduce sustainability of effective programming. Atkins et al. suggested that mental health services cannot be treated as an add-on, but must be seen as an integral element of the full school-wide continuum of behavior support for all students and their families. The purpose of this commentary is to commend Atkins et al. (2003) for promoting a "new model" of school-based mental health services and to expand this discussion by considering (a) the role of primary prevention, (b) the importance of a function-based approach to behavior support, and (c) an organizational and systems approach to sustainability.