Despite high rates of mental health concerns among youth, they are unlikely to receive mental health care, with mental health stigma acting as a barrier. The present study explores youth perceptions of the influences of stigma and what should be done to address it, drawing on a large (n = 705) mixed methods dataset of youth aged 14 to 24 from the National MyVoice Text Message Cohort. Thematic analysis indicated four themes: (1) perceptions of high levels of ignorance about mental health, (2) a continuum from a desire for greater openness to a desire for privacy related to mental health, (3) feeling shamed and dismissed for mental health concerns, and (4) the role of adults in perpetuating of mental health stigma and adults' responsibility in combating it. Subgroup comparisons revealed variations in endorsement of themes based on gender, age, and race/ethnicity. Implications for research and practice are discussed.