This chapter examines the unique challenges of addressing and responding to nonsuicidal self-injury (NSSI) within school systems. Specifically, the unique challenge of managing multiple stakeholders when addressing NSSI in students is examined. Although there has been considerable growth in the development and evaluation of NSSI guidelines and protocols for schools, they are often not enough to address the more complex situations schools encounter. This chapter examines the role of school mental health professionals in addressing complex NSSI, when to involve families in the treatment of a student, how to manage social contagion within a school setting, and consideration of how NSSI is conceptualized in different cultures. The chapter concludes with three case studies that exemplify some of the complexities in addressing NSSI in schools and offer responses that optimize the well-being of both the student and the school.