The multiple layers of exclusion that can be experienced by a child at school and the relationship of this to mental well-being is the focus of this paper. The relationship between specific mental health problems and school exclusion is discussed. Data gathered from 1648 English school-aged students in 2019 who participated in the OxWell school mental health and well-being survey and responded to the school exclusion question will be presented. Ninety-three pupils who self-reported having experienced school exclusion were compared to 1555 pupils in years 8, 10 and 12 who did not report experiencing school exclusion. More males were present in the excluded sample but apart from that the children share similar vulnerabilities for risk of mental health difficulties and risk of exclusion. Of note, a significantly higher proportion of those who had been excluded from school had experienced being bullied at school and reported that they felt their school dealt badly with bullying. They reported relatively good access to mental health support with a higher proportion of those excluded having accessed mental health support than those not excluded. The difficulties identified by the pupils need to be addressed in a variety of ways by school and health systems, and would benefit from the active involvement of young people in generating solutions. The discourse needs to move away from thinking about individuals to broader systems-level approaches to address pupil, family, school and community differences, difficulties and overall challenges of inclusion and acceptance.