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Despite growing concerns about mental health in Black adolescents, cultural factors influencing their help-seeking behaviors remain largely understudied. Pathways to formal mental health help-seeking and the influence of religion remain underexplored in Black adolescents. This study investigated the relationship between religious affiliation and formal mental health service utilization in Black adolescents using a mixed-methods sequential explanatory approach. Quantitative analysis (n=285) revealed that religious Black adolescents are more likely to seek mental health services from school-based professionals and less likely to use phone or text lines compared to their nonreligious counterparts. Using inductive thematic analysis, three themes were identified from qualitative interviews (n=6): Cultural and Community Emphasis on Religious Coping, Stigma and Dismissiveness, and Awareness of the Need for Additional Help. Findings underscore the need for culturally responsive mental health interventions and collaborations with community organizations to improve formal service access and utilization for Black teens. Implications for clinicians, educators, and community leaders focus on strategies to promote health equity and address systemic barriers to care in Black communities.