Background: Schools have become a primary access point for mental health services to cover the gap between need and service utilization that has long existed, particularly among vulnerable populations. This study aims to identify the profiles of comprehensive school mental and behavioral health system (CSMBHS) needs and examine related characteristics. Methods: We used the 2019 National Survey of Drug Use and Health (NSDUH) collected from a nationally representative sample in the United States. The sample included 6th through 12th-grade adolescents who had received CSMBHS services in the last 12 months (N = 1346). The study conducted latent class analysis and multinomial logistic regression using Vermunt's 3-step approach. Results: The analysis identified 3 profiles of student CSMBHS service need: depression needs (42%), multiple endorsements in most needs (depressed, friend, and school problems; 6.5%), and low endorsement (51.4%). Findings suggest that the profiles differed by age, a lifetime major depressive episode, family income, and use of other mental health services. Implications for School Health, Policy, Practice, and Equity: Emphasis should be placed on proactively identifying student needs and advocating for appropriate interventions based on student needs. Conclusions: The study reveals important information regarding how schools best support students in need and in seeking services.