Mental health treatment for incarcerated youth has been characterized by a shuttling between the justice and mental health systems. Depending on whether a youth is attached to the mental health system or to the criminal justice system, the priority for treatment changes. In the mental health system, common outcome measures relate to symptom reduction, reduced length of stay, readmission to the hospital, and quality of life. In the criminal justice system, on the other hand, reduction in the risk of recidivism has generally been the outcome of interest. A comprehensive treatment program for offenders with mental disorders must include both treatment for psychiatric symptoms and treatments that focus directly on criminal behavior. For the current analysis, a random sample of 312 juveniles in detention and correctional facilities in Maryland was selected for analysis. Service patterns and costs were determined, and selected variables were examined for their ability to predict which youth received mental health treatment. Only 23 percent of juveniles diagnosed with a mental disorder received any treatment. Older youth and African-American youth received fewer services, and race was the only significant predictor for receiving treatment. High costs were not associated with the provision of treatment services, but were more likely due to reliance on residential programming. When provided, mental health services were most often provided in the second episode of contact with the juvenile justice system, and services waned for youth with repetitive contacts with the system. 2 tables and 31 references