Youth with diabetes are at risk for suboptimal psychological functioning. This study evaluated the prevalence of concerns and proportion of outpatient referrals provided and completed at follow-up. Participants included 100 adolescents and young adults seen at a multidisciplinary diabetes clinic. Referrals were made to 61.2% of participants for internalizing (51.6%), externalizing (8%), diabetes-related (50%), comprehensive evaluation (17%), interpersonal (10%), and other needs (3%). At follow-up, 23.7% of those referred were enrolled in outpatient services. Pediatric psychologists offer effective mental health screening and referral. Barriers to follow-up outpatient care included transportation, organization, and stigma. Implications for improving access are discussed.