Youth suicide is a concern world-wide and suicidality, the presence of suicidal ideation or intent, is a critical risk for youth mental health services. This study aimed to determine the prevalence of suicidality in primary care, youth mental health services, along with its correlates and the course of treatment offered to clients. Routinely collected data from Australia’s headspace national youth mental health foundation, which has over 160 centres across Australia providing mental health care to young people aged 12-25 years, were analysed for new clients who started and completed their first episode of care between 1 July 2022 and 30 June 2023. This included 30,437 young people/episodes of care and 74,393 occasions of service. Results showed that suicidality was evident in almost one-quarter of young people, although it was rarely reported as a primary presenting issue. When evident, it was usually identified at first visit. Those most at risk were young people in unstable accommodation, who identified as LGBTIQA+ or who were Indigenous. The findings show that suicidality should be anticipated in young people presenting to primary care mental health settings, and youth services need to be able to competently deal with suicide risk rather than using this as exclusion criteria.