Background and Objective:
The increased need for mental health care has challenged the role of schools and school health care. According to political guidelines, mental health services should be an integrated part of the general health services, such as school health care. There is a need for future visions concerning the mental health services provided in the school environment. The aim of this research was to describe the variation in stakeholders perceptions related to the desirable mental health services in school environments and to construct alternative future visions based on these perceptions.

Methods:
The qualitative study was conducted with the phenomenographic approach using a visioning methodology. Interviews were conducted in Finland between February 2020 and February 2021. Professional stakeholders (n=15) participated in individual interviews and stakeholders advocating for adolescents or parents (n=10) in focus group interviews.

Results:
Four alternative future visions were formulated based on the perceptions of the stakeholders. The visions emphasised different aspects: (1) non-medicalising the school environment, (2) early and extensive intervention by school nurses enabled by work distribution with mental health specialists, (3) a multiprofessional team providing help on overall health questions and (4) a focusing of the services on mental disorders.

Conclusion:
The future visions are based on distinct and even opposite perceptions related to the mission and focus of school health care. One extreme emphasises overall health promotion for everyone, and the other treatment for those suffering from mental disorders. Selection of a desirable vision is challenging: the former may lead to inadequate help for mental health problems and the latter insufficient help for other problems.