Mental illness significantly impairs the lives of 10% of all children and adolescents in the United States (National Institute of Mental Health. Brief Notes on the Mental Health of Children and Adolescents. Bethesda, MD: National Institute of Mental Health, 1999). Of the myriad mental health problems afflicting children, an alarming number are known to have grim outcomes. Some illnesses continue into adulthood, while others may culminate in death during adolescence. Despite the serious consequences of children's mental health problems, early treatment can improve or control these conditions. Even with this knowledge, seemingly little effort is geared toward removing barriers to treatment for these diseases that plague our children. As a part of its five-year plan, Emergency Medical Services for Children (EMSC) has collaborated with the National Association of EMS Physicians (NAEMSP) to examine childhood and adolescent mental health emergencies--particularly their presentation and management within the emergency medical services system. This document presents a critical review of current practices and models for treatment of children and adolescents that includes identification of barriers to mental health treatment and recommendations for their resolution.