Schools are increasingly being seen as ideal locations in which to deliver school mental health (SMH) services via a multi-tiered system of support framework. Within this framework, Tier 3 services are provided to youth with the most significant level of mental health need. While schools employ a variety of SMH professionals to implement SMH services, there is some disagreement as to how these services should be delivered in the United States (U.S.). The current study used a national U.S. sample and employed a parallel convergent mixed methods methodology to describe participants' views on providing intensive mental health supports in a school setting. Specifically, we sought to examine SMH professionals' perspectives regarding: (1) the role of schools in providing intensive mental health support to students; and (2) who should provide intensive SMH services to students. Perspectives differed by locale as well as regarding what constituted "intensive mental health needs." Implications for practice, limitations, and directions for future research are discussed.