The Underuse of Clozapine and Long-Acting Injectable Antipsychotics

Psychiatr Serv. 2025 Jan 1;76(1):90-92. doi: 10.1176/appi.ps.20240110. Epub 2024 Oct 9.

Abstract

Schizophrenia is among the most devastating and costly human diseases. The public face of the failure to appropriately treat schizophrenia includes approximately 100,000 homeless individuals with schizophrenia and related psychoses and 200,000 incarcerated individuals with similar diagnoses. Clozapine and long-acting injectable antipsychotics are among the most effective treatments, but both are markedly underused. The following organizations should take responsibility for fixing this problem: National Institute of Mental Health, Patient-Centered Outcomes Research Institute, Substance Abuse and Mental Health Services Administration, Centers for Medicare and Medicaid Services, U.S. Food and Drug Administration, American Psychiatric Association, and patient and family advocacy groups.

Keywords: Homelessness; Jails and prisons/mental health services; Schizophrenia; Treatment guidelines; Violence/aggression.

MeSH terms

  • Antipsychotic Agents* / administration & dosage
  • Antipsychotic Agents* / therapeutic use
  • Clozapine* / administration & dosage
  • Clozapine* / therapeutic use
  • Delayed-Action Preparations*
  • Humans
  • Injections
  • Schizophrenia* / drug therapy
  • United States

Substances

  • Antipsychotic Agents
  • Clozapine
  • Delayed-Action Preparations