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Research in organizational sociology and the sociology of education has established a common disconnect between institutional myths—idealized, rational cultural ideals of what an organization ought to do—and organizational behavior—what people within an organization actually do. Much research in this area, however, has emphasized institutional myths that closely reflect schools’ dominant mission: to educate and graduate students, even though schools are often tasked with much beyond traditional schooling. We leverage insights from the broader organizational literature on schools as loosely coupled systems and inhabited institutions to understand schools as crucial sites for suicide prevention. Our data include interviews (N = 288), four years of ethnographic observations, and surveys with district families (N = 701) and staff (N = 568) from a community-engaged mixed-methods project in a Colorado public school district examining challenges and opportunities for suicide prevention. We analyze how school systems respond to local and external pressures to promote youth mental health and prevent suicide. Even when staff and families broadly support suicide prevention, they encounter many hurdles to enacting it in practice. A key challenge stems from the lack of district-level experts with the authority to translate abundant state guidance into policies tailored to the local context. Ambiguity intensified following an American School Counseling Association (ASCA) opinion blog questioning the role of school counselors in suicide prevention, which generated uncertainty about schools’ responsibilities. These complexities reveal how institutional ambiguity—are schools supposed to be preventing suicide?—can undermine the enactment of even broadly agreed-upon institutional myths and complicate organizational behavior. We use these insights to advance theories of schools as organizations and to offer practical policy insights for improving suicide prevention in schools.