Poised to have the highest number of young people in the world, India will have the onus of providing adequate mental health resources to a demographic considered among the most vulnerable with regard to mental well-being. While the Mental Healthcare Act 2017 pushed for greater accountability and care in supporting individuals with mental illness, these directions were specific to services provided by the state and did not address the care required in non-hospital settings. Since many manifestations and repercussions of mental health issues in young people occur in educational institutions, it becomes vital to address ways in which we can formulate ethical mental health services at those sites. This article is a reflective case study of the ethical dilemmas and challenges around issues of confidentiality and quality of care in relation to demand, contributing to a larger mental health ecology involved in providing mental health resources at the Student Support Centre, Manipal, that caters exclusively to students in an Indian campus town.