This study described mental health and substance use referral practices of resident assistants (RAs). Interviews were conducted with 48 RAs at three campuses. RAs generally had positive attitudes toward helping residents, and believed that existing norms supported their referral actions. However, many perceived referring residents to be emotionally burdensome, and they were not confident referrals would lead to positive outcomes. RAs reported referring residents for professional assistance only when problems were judged to be severe, essentially engaging in a form of clinical evaluation to make referral decisions. Recommendations for enhancing the continuum of care provided to distressed residents are discussed. (Contains 1 figure.)