In recent years, postsecondary institutions have experienced increasing demands for on-campus mental health care services as rates of mental health concerns continue to grow amongst the student population, particularly amongst marginalized groups of students, including lesbian, gay, bisexual, trans, and queer (LGBTQ+) students. Amidst claims to resource scarcity within the context of postsecondary mental health care, the Stepped Care 2.0 framework for organizing mental health care service delivery has emerged as an attractive methodology for (re)structuring postsecondary mental health care services, as the model claims to increase access to a diversity of services. Writing in the context of a large postsecondary institution in Ontario, the present qualitative study uses the critical qualitative methodology of institutional ethnography to examine how LGBTQ+ students experience care as organized by Stepped Care 2.0 model. Ultimately, our paper points to disjunctures between Stepped Care 2.0’s self-promotional claims to accessibility and the lived experiences of LGBTQ+ students, who have overwhelmingly reported that on-campus mental health care services have been difficult to access. Using qualitative interviews and textual analysis, we argue that LGBTQ+ students’ difficulties with accessing the care they need can be attributed to the structure of the Stepped Care 2.0 model itself, namely its focus on One-At-A-Time, short-term therapy. Our paper aims to be critically additive to the existing body of research on Stepped Care 2.0 and ends with a discussion of the implication of our work for academic literature, policy, and practice.