<p>This article explores how persistent school absenteeism becomes institutionally organised as mental health problems through the case of Emma, a pupil in a Norwegian compulsory school. Drawing on institutional ethnography and inspired by Dorothy Smith’s essay “K Is Mentally Ill,” I examine how two of Emma’s teachers came to understand and respond to her situation as a case of “anxiety” and “school refusal”—despite her withdrawal from both school and follow-up, and the presence of plausible alternative explanations. The analysis demonstrates how their actions were shaped by institutional texts and accountability regimes that rendered psychological framings not only legitimate but also necessary. I argue that this framing was sustained by a dominant institutional discourse of “returning to school”, in which school attendance comes to be treated as the unquestioned solution to pupil distress. The article highlights how such discourse narrows the interpretive repertoire available to professionals, often excluding social or structural explanations and limiting children’s opportunities to be heard on their own terms.</p>