Objective: Rates of mental illness among young people remain elevated, and the utilization of youth mental health services is expected to increase. Yet, there is limited knowledge on real-world medication usage and prescribing at these services. Hence, the aim of this study was to explore the medication prescribing patterns at a headspace center, an Australian youth mental health service.Methods: A retrospective cross-sectional study of medical records was conducted. Demographic data, clinical information, prescribed medications, and reasons for use of young people who attended an intake assessment at headspace Camperdown over a 13-month period, February 2021-February 2022, were analyzed. Data collection focused on medication molecule, strength, dose, prescriber designation, and indication. Data were analyzed descriptively.Results: Records for 608 participants were included. The median age at intake was 19.9 years old (interquartile range: 16.1-22.4), and most participants identified as female (n = 372, 61.2%). Anxiety (n = 246, 40.5%) and low mood (n = 95, 15.6%) were the most common presenting concerns. Almost half of participants (n = 291, 47.9%) reported using medication/s at intake, and almost one in five participants (n = 119, 19.6%) were prescribed a medication at the service. The most prescribed medications at headspace were melatonin (24.0%) and quetiapine (12.3%), as well as the antidepressants escitalopram (15.1%), sertraline (11.2%), and fluoxetine (7.3%).Conclusions: This study provides insights into the prescribing practices at a single headspace center. Further investigations are needed to explore the impacts of off-label prescribing for young people, particularly in relation to melatonin and quetiapine, where safety and efficacy in young people have not been well established.