To date, few studies have assessed the prevalence of mental health conditions among runaway youth who have been located by law enforcement. Given that repeat runaway cases disproportionately consume more investigative resources from law enforcement agencies, it is important to ascertain risk factors of this population. Using a sample of one-time and repeat runaway youth from one large police agency in Texas, this study investigated differences in the mental health needs of youth reported as runaways to the police. Results from the logistic regression model showed that repeat runaway youth were more likely to be older, female, and have multiple mental health diagnoses compared to one-time runaways. No differences were found in the length of time a youth was reported as missing prior to being located by police. These results show that police encounter a large proportion of runaway youth with complex mental health needs.