Japan's healthcare system is primarily focused on general care, and psychiatric services are mainly concerned with institutional solutions to serious mental health issues. As a result, child and adolescent mental health services (CAMHS) have been slow to develop, and there is a limited evidence base to guide treatment. As such, providing treatment to this population is a challenging endeavour. This landscape piece aims to illustrate the current state of child and adolescent services in Japan and provides a description of a recently opened private clinic for children with mental health conditions in Kuroyashi, a city in the Tottori prefecture. The vignette describes steps taken by the clinic's director to overcome systemic challenges and increase access to mental health services to children and adolescents.