Child and Adolescent Mental Health Services (CAMHS) have been under intense pressure for many years, but a lack of alternative rural social infrastructure and a fall in support for youth services means CAMHS is often the “only show in town”. However, focussing on providing ‘reactive’ mental health services will only go so far, especially given CAMHS waiting times, so the focus and resources need to shift to prevention. Early intervention via Mental Health Support Teams (MSHTs) is a positive development but needs to be rolled-out to all rural schools as soon as possible and adequately resourced with appropriately trained staff given the many responsibilities on schools. Youth service provision in rural areas also needs to be expanded but until that is delivered, whilst demand is high on CAMHS, and alongside MHSTs, much more investment is needed in other forms of prevention such as ‘Early Support Hubs’. Therefore, we recommend that DHSC, NHS England and DEFRA consult on proposals to reduce reliance on CAMHS by expanding preventative mental health support for children and young people by, (a) setting out a path to expand provision of MHSTs to 100% of schools and colleges in rural areas by 2026/27, and (b) committing to establish and fund ‘Early Support Hubs’ that can be accessed by children and young people in rural areas by 2024/25.