The recent uptick in students exhibiting mental health needs within American public schools has emerged as a concerning trend amongst educators. A plethora of research has occurred on the proliferation of student mental health needs in schools, along with its consequential influence on both teaching and learning. Absent from the current literature on student mental health is the principal voice. As school leaders, principals are called upon to provide ideas, assistance, and direction for students displaying mental health concerns. For many school principals, addressing student mental health requires additional time and energy during school hours. A gap in research exists relating to principals and their first-hand observations of the impact of student mental health on their role, as well as their ability to assist students exhibiting needs. The purpose of this phenomenological case study was to examine the phenomenon of student mental health and the held perceptions of elementary school principals in Western Maryland relating to their ability to assist students. Specifically, the principal's training and education, ability to direct school-based supports, ease of soliciting community resources, and the impact to the principal's daily schedule are relatively unknown. The case study utilized a three-tiered approach to reach triangulation of the data: questionnaire, focus group discussion, and individual interviews. Thirty-four distinct principals participated in the research for this study through one of the three tiers. Findings indicated that principals have a solid background on root causes and symptoms of student mental health, along with basic knowledge of working with some types of student behaviors. Principals perceive their biggest needs to be additional human resources in school buildings, more specified training in severe disruptive behaviors, and assistance from the medical community in both collaboration with school systems and hiring additional medical staff to treat students and educate families in their communities. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://bibliotheek.ehb.be:2222/en-US/products/dissertations/individuals.shtml.]