In the contemporary delivery of mental health care, clinicians face challenges that often go beyond providing evidence-based treatment. Abuse and trauma constitute enduring challenges, with increasing rates in current community practice. Alongside abuse and trauma, adolescents at suicidal risk often resist treatment and require interventions on social networks that are themselves often disjointed in nature. Finally, some hard-to-reach youths present situations that add up all risk factors for severe psychopathology: early abuse and neglect, risk for self harm and harming others, and severe socioeconomic adversity. This symposium presents different complex clinical situations for which reflective functioning constitutes the key process that requires clinical attention for delivery of situation-specific mental health care. The contextual determinants of each clinical context calls for specific application modalities, yet the aim of interventions critically involve reflective functioning/mentalization as an operating principle in therapy, supervision, and network collaboration. This symposium will sequentially address these complex situations through four oral presentations.