This study describes failure to seek health care among 673 new adult clients seeking mental health services in the San Francisco Bay area. Overall, 49% (n = 328) reported a failure to seek health care they believed was needed in the past year. People with dual diagnosis, severe depression, chronic physical illness, fear of coercive treatment, private insurance, and no insurance were more likely to fail to seek health care. Greater use of private physicians decreased the odds of failure to seek health care. These findings highlight the need to target groups at risk for failure to seek health care and the need to design nonthreatening programs to improve health access for people with mental illness.