In order to address the unmet need for prevention and treatment of psychological distress and mental disorders, program planners and treatment providers need to identify individuals at high risk. The results of the California Health Interview Survey from 2009 (n = 47,614) indicate that there are high relative risks by demographics and smoking status for reports of psychological distress and intermediate measures: feeling nervous, hopeless, worthless, depressed, restless, and that everything is an effort. Specific demographic factors and smoking status can predict a greater need for prevention and treatment of psychological distress and lack of insurance coverage for treatment. Profiles associated with high risk can help in referral for diagnosis or to plan prevention programs.