Background: Secondary school can be a stressful period for adolescents, having to cope with many life changes. Very little research has been conducted on the mental health status of secondary school pupils in South East Asian countries, such as Vietnam.The study aimed to explore perceptions of mental health status, risk factors for mental health problems and strategies to improve mental health among Vietnamese secondary school students. Methods. A qualitative design was used to address the main study question including: six in-depth interviews conducted with professionals (with two researchers, two psychiatrists, and two secondary school teachers) to learn about their experience of mental health problems among secondary school pupils; 13 focus group discussions (four with teachers, four with parents, and five with pupils); and 10 individual in-depth interviews with pupils who did not take part in the FGDs, to reflect on the collected data and to deepen the authors' understanding. All interviews and FGDs were audio-taped, transcribed and analyzed for the identification of emerging issues using qualitative techniques of progressive coding, analytic memoing and ongoing comparison. Results: Our study confirms the need to pay attention to mental health of pupils in Vietnam. Depression, anxiety, stress, suicidal thoughts and suicide attempts were seen as major problems by all stakeholders. Mental health problems were mainly associated with academic pressure, resulting from an overloaded curriculum and pressure from teachers and parents to succeed. The study found that pupils' mental health demands interventions at many levels, including at the level of government (Ministry of Education and Training), schools, communities, families and pupils themselves. Conclusions: Vietnamese secondary school pupils feel that their mental health status is poor, because of many risk factors in their learning and living environment. The need now is to investigate further to identify and apply strategies to improve students' mental health.