Knowledge about how young children develop and thrive has been growing over the past decades. So too have understandings about how environmental and biological risks can affect their cognitive, physical, and social development (Meisels & Shonkoff, 1990). This knowledge formed the basis of special education laws to create incentives for the development of family-centered services to young children with developmental delays or disabilities or, in some instances, those at risk of delays and disabilities. In theory, these laws include attention to social and emotional problems in young children. Yet, in practice, little policy or practice has focused on family-centered services to young children with emotional or behavioral disabilities or those at high risk of developing them (Knitzer, 1996a,b). Put differently, little attention has been paid to what, for the purposes of this chapter, is called “early childhood mental health.” This chapter argues that the need for early childhood mental health services and systems development is critical. To make the case, it draws on knowledge reported by practitioners and on empirical data to the extent that these are available. (Unfortunately, because this is an emerging field of public concern, it has not yet been well studied.) This chapter also highlights the potential connections between meeting publicly espoused early childhood social goals and addressing early childhood mental health issues. Finally, it argues that barriers and obstacles to creating responsive policies and nurturing a field of practice are considerable and pose some general directions for action.