Largely as a result of early adverse experiences, children and young people in care are more likely to suffer from mental health difficulties than their peers. Despite these difficulties, they tend to find it hard to seek help and engage with professional services to address their needs. In Northern Ireland, the Mind Your Health study collected data for 233 children and young people in care through phone interviews with their carers, and 25 of these young people were interviewed. Focus groups with professionals were also carried out. According to their carers, 35% had diagnosed emotional difficulties, and 36% scored in the abnormal range for the Strengths and Difficulties Questionnaire’s emotional symptoms scale. Carers described difficulties in accessing mental health services for young people, due to lengthy waiting lists, a lack of information offered, and a lack of effort to engage them. Young people found it difficult to engage with these services because of their feelings of stigma, embarrassment, insecurity, guilt and fear. Some felt unable to seek help even from their families and friends. We recommend that mental health services are made more locally accessible, waiting times are reduced, with a greater emphasis on proactive outreach work.