An analysis of data from the Youth19 Rangatahi Smart Survey has shown that youth mental health is not “one size fits all”. The survey, conducted in 2019, included 7721 adolescents aged 13-18 years. Six variables from the survey were analysed: wellbeing; possible anxiety symptoms; depression symptoms; past-year self-harm; suicide ideation; and suicide attempt. Five clusters of mental health were identified. The healthy cluster (40.3% of adolescents) reported positive mental health; the anxious cluster (28.2%) reported high possible anxiety symptoms but otherwise generally positive mental health; the stressed and hurting cluster (9.4%) reported subclinical depression, possible anxiety symptoms and some self-harm; the distressed and ideating cluster (15.8%) reported clinical depression, possible anxiety symptoms and high suicide ideation; and the severe cluster (6.4%) reported the least positive mental health across all indicators. The higher severity clusters included an overrepresentation of female, rainbow, Māori and Pacific students, and those from higher deprivation areas. Exposure to sexual harm and discrimination were also associated with increasing cluster severity. Future research should consider how to best support the mental health of each cluster, concluded the study authors.