Mental disorders among adolescents are on the rise and are among the most common chronic conditions, constituting a national epidemic. Prevalence rates indicate that 20–40% of the adolescent population in the U.S. suffers from emotional or behavioral difficulties significant enough to lead to functional impairment. Further, estimates suggest that more than 20% of the adolescent population has a diagnosable mental disorder, which significantly impacts their functioning substantially at school, at home and in their communities. Despite national agendas to address the mental health needs of adolescents, studies suggest that approximately 50 percent of adolescents with mental health needs do not seek mental health services. Framed within the Andersen Behavioral Health Model, the objective of this research was to identify and describe the factors that contribute to the under-utilization of mental health services among adolescents. A qualitative meta-synthesis of the literature was conducted to identify the contributing factors. The goal of a meta-synthesis is to provide a greater depth of knowledge and a more extensive understanding of both the theory and the phenomena being studied. A meta-synthesis of 12 qualitative studies was conducted. Focusing on qualitative studies provides a deeper understanding of the contextual issues involved in the utilization of mental health services for adolescents. Findings from this study suggest that need and enabling factors are important drivers of mental health service use and adolescents’ and parents’ perceptions of services, providers, and sigma are particularly important to determining use of services. The study also identified that opinions of families and peers can influence whether or not an adolescent will remain in treatment. It is critical to increase understanding of the role social networks as many adolescents suggest their network may provide some form of informal support. It may be beneficial to focus specifically on the provision of peer-delivered support services for adolescents as well as develop and implement strategies aimed at improving perceptions around mental health. Adolescence is a critical point in time when social and emotional development are encouraged; if mental health needs are not addressed during this developmental stage, many adolescents will potentially experience more severe disorders in adulthood.