The objective of this study was to examine mental health follow-up patterns and need for additional urgent ED evaluation in adolescents discharged home from a pediatric ED after an evaluation for suicidal ideation or attempt. In the study, the parent or guardian of suicidal youth ages 11 to 18 years who were discharged from the pediatric ED were interviewed by telephone between 1 and 2 months following the initial visit and asked about their child's suicide risk, mental health follow-up, return ED visits, and previous mental health experiences. ED records were also examined for return visits. A parent or guardian of 100 suicidal adolescents was interviewed by telephone. Most (66%) successfully followed up with a mental health provider. Mental health follow-up was more likely in those with an existing psychiatric diagnosis (OR: 3.03 [95% CI: 1.02-9.05]). The majority of those that returned to the ED within 2 months of their initial evaluation for mental health reasons were admitted [92% (19/21)]. The odds of an ED return visit were increased by a prior inpatient psychiatric admission (OR: 5.23 [95% CI: 1.80-15.16]), and a suicide attempt immediately prior to the initial ED visit (OR: 4.87 [95% CI: 1.04-22.69]). Many suicidal youth who are discharged from the ED successfully follow up with an outpatient mental health provider. However, a significant number do return to the ED within 2 months and require inpatient psychiatric admission. Future ED based interventions should focus on adolescents who attempt suicide and those with a history of prior inpatient admission.