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What role does child psychotherapy have to play in addressing the mental health needs of children in areas of disadvantage? This paper will discuss an innovative programme of school-based mental health work, led by child psychotherapists in Bristol. Referencing child psychotherapy’s early work with severely deprived children, and the pioneering work in schools by colleagues such as Youell and Jackson, the paper describes how the Bridge in Schools (BiS) has developed a local response to the high level of unmet mental health needs of children, especially in deprived areas of the city. We consider the challenges and opportunities to be found in building partnerships with school teams, and applying child psychotherapy in a school environment. We explore the relevance of child psychotherapy, both in developing therapeutic approaches to learning and behaviour management that provide containment for vulnerable children, and in offering effective and timely therapeutic interventions. We draw on evaluation data to show that this approach can significantly improve access and outcomes for families who currently do not reach CAMHS thresholds. Finally, we consider how these developments in child psychotherapy give us unique opportunities to contribute to the government’s current re-design of child mental health services.