This study examined mental health service use among three groups of young adults with assessed psychological distress: no perceived need for treatment, reported unmet need, and received treatment. Data came from participants ages 18 to 25 in the National Survey on Drug Use and Health (2008–2013) who met criteria for psychological distress (N = 19,775). Demographic, access-, and need-related predictors of perceived need and treatment group were examined by using multinomial logistic regression. Half the sample did not perceive a need for treatment (51.0%), and only one-third had received treatment (33.7%). White youths were more likely than those from other racial-ethnic groups to perceive a need and to receive treatment. Men were less likely than women to perceive need but equally likely to receive treatment. Higher education and having insurance also predicted treatment receipt. Efforts to increase service utilization among young adults should increase awareness of mental health problems and facilitate access, particularly for racial-ethnic minority groups.