Adolescents forego mental health care in spite of self-perceived needs for services; this presents a significant public health problem. Using data from the 2001 Adolescent Health Care Access Survey of 16-year-olds in Saint Louis County, Minnesota, we assessed barriers to mental health care among the 878 respondents who reported ever needing psychological or emotional counseling. Demographic characteristics were compared among those who had always, had sometimes, or had never received needed mental health care. Overall, 57% of the youths reported foregoing mental health care at least once. Girls and adolescents living with both parents were significantly more likely to have foregone care. Youths identified two common barriers to accessing care: "Thought or hoped the problem would go away" (50%) and "Didn't want parents to know" (36%). School-based interventions should be sensitive to mental health needs, especially among girls and teens living in two-parent families. (Contains 4 tables.)