The school setting represents the most common setting by which youth receive mental and behavioral health (MBH) services (Farmer et al., 2003, Psychiatr Serv, 54, 60-66). Nevertheless, many school psychologists are not providing MBH services despite the high prevalence of need. Additional research is needed to understand factors leading to these deficits, as well as potential solutions to ameliorate these concerns. The current study surveyed 341 school psychologists across seven states and found current ratios are one school psychologist for every 1,500-2,000 students. Study results suggest school psychologists are providing a half to full day of universal, prevention-oriented MBH services each week whereas more targeted, direct services (e.g., individual or small group counseling) are offered 1-4 hr each week. The school psychologist-to-student ratios also demonstrated a statistically significant and inverse association with the provision of targeted MBH services, with higher ratios resulting in fewer MBH services. Respondents provided potential solutions for how to expand the delivery of MBH services within schools, including increased awareness and support among school and district administrators, as well as access to training and professional development related to MBH services.