Background: Refugee background young people are at increased risk of mental health problems. In countries of refugee resettlement, schools are important sites where mental health difficulties can be identified and service access facilitated; however, little is known about how best to support these practices within schools. Methods: This article explores school and mental health service providers' perspectives on mental health challenges and referral pathways for refugee youth in South Australia. It draws on semi-structured in-depth interviews with 17 secondary school staff and 10 mental health service providers, which were analyzed thematically. Results: Key challenges for school staff in identifying mental health issues were understanding behaviors, overcoming stigma, cultural and linguistic barriers, engaging with parents, staff preparation and training, and embeddedness within Western understandings of mental health. There was also limited awareness of appropriate mental health services and referral pathways. Service providers recognized schools' key role in identifying mental health issues for refugee students. Conclusions: Enhanced training and support is required for teachers to identify and refer students who might be experiencing mental health issues. "On-site" school services, bi-cultural workers, and increased knowledge of existing within-school supports and referral pathways to external services would enhance outcomes for refugee students.