Youth suicidal behaviour poses a significant public health concern. Mental health care professionals working in schools have an important role to play in youth suicide prevention initiatives, although little is known of the experiences of this group of professionals in the developing world. The aim of this study was to explore the experiences of mental health professionals working in South African schools and document their insights, attitudes and beliefs regarding youth suicidal behaviour. In-depth semi-structured interviews were conducted with seven school-based mental health care professionals and data were analysed using Thematic Analysis. Participants reported that they relied on a reactive strategy by responding to youths who were in crisis. They were challenged by a lack of support from faculty staff, lack of access to resources, and heavy caseloads. Findings highlight the need for a proactive and collaborative approach to suicide prevention among mental health care professionals, teachers and parents in South African schools and improved training and supervision.