Widespread concerns about adolescent mental health difficulties have generated intense debate and resulted in adolescence being high on the policy agenda. Recent government investments aim to ameliorate widely criticised services for adolescence, and redress the negative images of young people. In order to explore the current state of knowledge regarding adolescent mental health, and relate this knowledge to practice, this paper explores three key questions: are adolescent mental health problems increasing, are adolescents dislocated by new and different contexts, and what are the levels of mental health difficulties in adolescence? The paper suggests that evidence that adolescents are ‘getting worse’ is not convincing, but it is clear that the contexts for adolescence have changed radically and this affects adolescent developmental processes. Adolescent mental health difficulties require a current, developmentally relevant and oriented approach to enhance effective understanding and intervention. Adults in general and professionals in particular need to be able to engage with and not take flight from the impact of adolescent emotionality.