Online synchronous chat, or ‘Live Chat’, is distinguished by its real-time, anonymous, and text-based nature. There is limited understanding of the characteristics of those who choose Live Chat services compared to Blended Services. This study examined the demographic, psychosocial, and service engagement profiles of young people using the Irish Live Chat service, Jigsaw Live Chat, compared with those attending Jigsaw’s Blended (in-person and/or video) support Service. Routine service-based data were analysed from 1,313 Live Chat and 3,604 Blended Service users. Reasons for attendance among Live Chat users seeking mental health support were analysed using content analysis. Live Chat users were more likely to be gender-diverse, older, and to report higher psychological distress than Blended Service users. Anxiety and low mood were common presenting issues. Attendance reasons varied, with over one-third citing multiple issues and many experiencing persistent distress. A minority attended for information or while waiting for other support. Overall, users reported high satisfaction. Live Chat users waited an average of 2.5 minutes, compared with typical waits of 1–2 months for the Blended Service. These findings highlight Live Chat as a distinct and essential access point for highly distressed and underserved youth, particularly those with minority gender and sexual identities.