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Background Mobile phones play a central role in the lives of young people and are being increasingly recognized as valuable tools in health care. However, there is a paucity of studies exploring the use of mobile phones in youth outreach mental health services. Our outreach team's experience is that enabling youth to access their therapist directly through mobile phone improves engagement and retention, and short message service (SMS) in particular, is a useful tool for coordinating appointments. The purpose of this study was to audit the content of SMS exchanges between therapists and clients and to investigate the extent of inappropriate SMS use. Method An audit of SMS messages sent and received from an outreach youth mental health service was conducted over a 7-month period. Results The majority of SMS traffic sent to and received from clients was micro-coordinating face-to-face-meetings (76% and 61%, respectively), reflecting a practical real-time use of SMS. Only a small proportion of the client use of SMS was classified as inappropriate (2%). Conclusions The results demonstrate that mobile phones and SMS can be used as a safe, practical way of maintaining contact and coordinating meetings within a youth outreach service.