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Background: Mental disorders are common in school-going students and have been evidenced to cause truancy. However, a little is understood about the relationship between severe mental health symptoms and truancy in the ethnic minorities. The present study explores mental health factors associated with truancy among high school students in Malaysia with a focus on those who are from the ethnic minority groups. Method: Nationally representative data with a large sample size (n = 8794) are used for secondary analyses. Mental health symptoms, as well as demographic and lifestyle characteristics are used as explanatory variables. Logistic regressions stratified by ethnicity are conducted to compare the odds of truancy in the ethnic minority groups. Findings: There are positive relationships between the likelihood of truancy and severe symptoms of anxiety and depression, suicidal ideation, grade level, males, having single parents, rural locality, smoking, drinking, and use of illicit drugs. These relationships vary across ethnic minority groups. Conclusion: Our study casts light on the important relationship between mental health symptoms and the decisions of ethnic minority students to play truant. Our findings could provide policy makers with a better understanding of which types of students are more or less likely to be truant. Thereby, a more effective intervention measure directed towards reducing truancy among the ethnic minority students can be formulated.