The complex issues of promoting student mental health, privacy and public safety, and the balance among them, weigh on the minds of institutional leaders, educational policymakers, and local, state and federal officials. American campuses have a proud history of intellectual freedom, openness and public accessibility to their communities. However, the Virginia Tech shootings on April 16, 2007 marked a watershed in American campus violence, casting light on wide-ranging areas of concern. The purpose of this paper is to provide background information on student privacy and campus security, and to review best practices that college and university leaders may consider to help ensure that a system is in place to simultaneously maximize an open community and manage public safety preparedness and responsiveness. The author concludes that there cannot be a single mandated course of action for institutional procedures in handling extremely troubled students, although certain basic guidelines can be distilled for institutions to adapt as their individual circumstances fit: (1) Institutions must understand and clearly communicate to their faculty, administration, staff and students what applicable federal and state law allows regarding the treatment of students with mental health issues; (2) Institutions must set up clear, consistent lines of external communication with local law enforcement and appropriate state officials regarding legal issues, threat assessment, and the coordination of unified crisis management communications in the event of a large-scale emergency; (3) Institutions should, as far as possible, encourage an institutional climate and develop policies to ensure that students facing mental health issues feel safe in seeking help without fear of retribution; (4) Institutions and their local communities should work together in identifying mental health treatment gaps in the community and advocating in common for increased mental health treatment resources; (5) Institutions should examine their available on-campus resources in terms of mental health treatment and determine (with state and local involvement as appropriate) the feasibility of expansion; (6) Centralized threat assessment teams should be set up at the institutional level and involve not only student services, but faculty, campus law enforcement, off-campus law enforcement, and mental health services personnel as appropriate. The suggestions offered are not envisioned as firm guidelines, and the author advocates that campus-level administrators and system executives must be allowed flexibility to adapt policies to their own campuses. The document concludes by reiterating the fundamental need for communication and understanding among all higher education stakeholders regarding mental health issues. The author urges that with communication and understanding, reasonable yet compassionate policies can be crafted and information can be shared as widely as appropriately and legally possible for the purpose of helping students with mental health issues succeed and thrive while simultaneously maximizing campus security. A list of resources is provided. (Contains 43 endnotes.)