In recent years, there has been an increase in mental health struggles among Black girls, with concurrent increases in interpersonal violence in this group. However, there has been limited research into the structural, environmental, and psychosocial risk factors associated with these increases. A lack of understanding of these dynamics has left a gap in the implementation of targeted mental health and violence prevention/mitigation strategies for this sociomedically vulnerable population. Using semistructured interviews with staff at five high schools in the metropolitan Chicago area (n = 32), including teachers (n = 14), administrators (n = 9), and security officials (n = 9), we assessed perspectives on the mental health profiles and violence involvement of Black teen girls using abductive analysis and constant comparative methods. Respondents consistently indicated that violence was either more frequent among Black girls or felt more intractable, relative to (Black) males or other non-Black female students. Primary risk factors discussed included Black girls' recurrent exposure to neighborhood deprivation and limited psychosocial and institutional support. Black girls who perpetrate or are victims of violence face complex identity formation challenges that are amplified by mental health challenges resulting from broader racial and gendered structures. School and community-based interventions must consider the intersectional complexities that entrench mental illness and violence in this population as a clustered co-occurring phenomenon, focusing on structural and in-school supports and adult stakeholder trainings around implicit bias and cultural humility.