Health clinics within schools are designed to provide comprehensive care to the student population. Little research has been conducted to identify how effectively school-based health clinics are meeting the mental health needs of adolescents. This qualitative study explored the perceptions of mental health needs of 18 inner-city teens between 12 to 18 years of age with diagnosed behavioral or mental health issues. A single, face-to-face, semi-structured interview was used to examine students' concerns and attitudes toward their health care needs and services. Results revealed concern for their personal and family relationships, education and vocational goals, health maintenance, and financial independence. Most pressing resource needs related to their ability to receive health maintenance and coping skills and to adapt to complex life challenges they faced in their urban neighborhood. Participants remarked that if the clinic did not identify their needs for mental health care, they would most likely have not received services. When mental health care needs were identified, individual counseling was used to support dialogues for optimal mental and physical health.