This study compared demographic, academic, and clinical characteristics of adolescents at risk for mental health problems who either did or did not request help during a voluntary mental health screening. High school students completed a self-report to identify risk of mental health problems (n = 364). Students at risk were administered a clinical interview. Among those at risk, we compared those who requested help (n = 61) to those who did not (n = 22). The group who did not request help had a larger proportion of Caucasian students, higher grades, fewer days absent, and fewer detentions than their counterparts. In addition, those who did not request help were significantly more likely to report suicidal ideation in the preceding 3 months (63.6% vs. 27.9%, p less than 0.001). Relying on adolescents' requests for help alone would likely not identify many of those with suicidal ideation. Two-stage voluntary mental health screenings increase the detection of these adolescents at risk.