An increasing number of students with mental health disabilities (MHDs) are enrolling at Canadian colleges and universities. This review examines the challenges and complexities of meeting the unique needs of these students at Ontario's postsecondary institutions, with a specific focus on the issue of academic accommodations. These complexities include: delays in receiving a diagnosis, the episodic nature of MHD-related symptoms, and challenges in determining functional impairments. The present review highlights the current factors influencing the integration and academic success of this population of students, the importance of faculty education, stigma-reduction programs and the development of a "welcoming culture" on campus. Accommodation issues are also discussed such as the need for retroactive accommodations, which are more likely to be required by this population because of the intermittent and episodic nature of many MHDs. Retroactive accommodations are not currently included in the typical formal academic accommodation procedures used in Ontario. The authors conclude by pointing to the need for the development of documentation practices and effective policies to assist postsecondary institutions in designing the most appropriate academic accommodations for in-class and fieldwork essential requirements.