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Results of collaborations with juvenile justice agencies nationwide were examined to provide generalizable estimates of psychiatric disorder and suicidality among justice system youth. Diagnostic assessments were aggregated from 57 sites (N = 9,819) from an automated computer-assisted self-interview (Voice Diagnostic Interview Schedule for Children). Disorder was predicted from setting type (system intake, detention, corrections), adjusting for demographic and offense characteristics, and for cross-site variability within settings. Race by comorbid disorder interactions were examined in predicting substance use disorder (SUD). White youth, repeat offenders, and those with further justice system penetration reported higher rates of most disorders; girls reported higher rates of internalizing conditions only. Although presence of another disorder increased SUD for most groups, SUD was high in American Indians regardless of either affective disorder or recent suicide attempt. Findings highlight (a) varying mental health needs across settings, (b) prior justice contact relating strongly to need, (c) girls' elevated rates of internalizing disorder, and (d) racial/ethnic differences in diagnostic profiles.