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Significance This study uses a large national database of insured adolescent children who have an initial insurance claim for a mental illness. Many of these children either fail to receive follow-up care within 3 mo, or receive care that appears to fall short of standard guidelines for the initial treatment of mental illness in children. The majority do not receive therapy, and many children receive drugs that raise a red flag, such as benzodiazepines, tricyclic antidepressants, and drugs that are not Food and Drug Administration-approved for use in children. Very little of the variation in these outcomes can be explained by shortages of mental health professionals.

Treatment of mental illness in American adolescents varies widely within and across areas