A Goldilocks Approach to Youth Psychotropic Prescribing.

Abstract

Psychotropic prescribing in youth is increasingly debated through concerns regarding both overmedicalisation and unmet mental health need. Rising rates are often interpreted as evidence of overprescribing, yet clinicians often operate in under-resourced services, with long waiting lists and limited access to psychological therapies. This paper argues that the key issue is not whether prescribing rates are too high, but whether prescribing is proportionate to clinical need. Drawing on international and recent Irish CAMHS prescribing data, we propose a "Goldilocks model" of psychotropic prescribing in youth, in which optimal prescribing lies on a continuum between the extremes of under- and over-prescribing. This position is shaped by evidence, patient factors, and service context. While psychotropics have an important evidence-based role within child psychiatry, safe and effective use depends on accurate assessment, appropriate monitoring, and access to multidisciplinary and psychosocial supports. Achieving proportionate prescribing therefore requires systems capable of supporting evidence-informed, ethically grounded, and developmentally informed care, ensuring treatment is neither too much nor too little, but ultimately "just right."