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One of the most pressing challenges for schools’ implementation of universal school-based mental health supports is a limited understanding of the potential side effects. In this review, we explore the question, “What are the side effects of universal school-based mental health supports?” We answer this question by integrating scoping review and environmental scan methods, providing a comprehensive picture of the academic literature as well as policy- and practice-based insights. The sources included in this review discussed how the side effects of universal supports include school staff (a) feeling the strain of resource and time pressures resulting from integrating mental health programming into already demanding school schedules, (b) expressing mixed attitudes and commitments, and (c) perceiving variable program effectiveness and impacts.