In the United Kingdom, the issue of health and social care of young people is now a major concern for the government. Thus, a recent government green paper has insisted on the provision of early and appropriate interventions for young peoples' mental health difficulties and that their views must be incorporated into the design of mental health services. More recently, the NHS Health Advisory Service has recommended that schools and teachers should assume some responsibility in the identification of pupils who may have mental health difficulties. Unfortunately, there is scant information in the United Kingdom on young peoples' pathways into services. We know very little about their help-seeking strategies and service use, barriers or facilitators to care, satisfaction with services and service preferences. In addition, we have limited knowledge of how young people conceptualize mental health or how they perceive mental health professionals. In brief, the needs and help-seeking behaviours of young people in psychological distress are poorly understood and often mediated through older people such as parents and teachers. In this paper, we examine these issues and discuss the implications of such gaps in the evidence base for our understanding of adolescent help-seeking and our ability to provide appropriate well-targeted services.