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We aimed to provide the most comprehensive picture, to date, of service utilization and help-seeking behavior for mental health problems among college students in the United States. We conducted online surveys in 2007 and 2009 of random samples of students in 26 campuses nationwide. Among students with an apparent mental health problem (32% of the weighted sample), 36% received any treatment in the previous year. The prevalence of psychotherapy and medication use was approximately equal. Treatment prevalence varied widely across campuses, with some campuses having prevalence 2 to 3 times higher than those of others. Apparent barriers to help-seeking included skepticism on treatment effectiveness and a general lack of perceived urgency. Overall, the findings indicate that help-seeking for mental health varies substantially across student characteristics and across campuses. Strategies to address the low prevalence of treatment will need to be responsive to this diversity.