The division of student affairs within higher education institutions faces continuous change as the demand to respond to college student mental health increases. The research literature describes the progression of student affairs and the increase of severe student issues as mental health becomes a more prominent challenge on college campuses. The following phenomenological, multi-site case study examines the lived experience of student affairs professionals at a variety of institutions as they respond to college student mental health. Interviews and artifact analysis revealed themes that describe the demands and consequences of the college student mental health phenomenon within student affairs. Effectively responding to student needs requires innovation, a vast network of professional relationships, self-care, and student-centered policies and procedures. Additionally, the study emphasizes the role of institutional structures in supporting students and the professionals who support students. This study suggests that effective responses to the mental health phenomenon on campuses has complex and significant implications for student affairs professionals and college student success.