CLOZAPINE USE BY STATE PROGRAMS - PUBLIC MENTAL-HEALTH SYSTEMS RESPOND TO A NEW MEDICATION

The authors present data from a national survey of state departments o f mental health showing that two years after reaching the U.S. market, clozapine is available to only a small fraction of the patients whom it might benefit. The primary continuing hurdle for the public sector, where most schizophrenic patients get their care, is funding. Several arguments support the use of clozapine in state mental health systems : it is the most effective or only effective medication for many patie nts, it can decrease the enormous costs of schizophrenia and related d isorders, and access to the medication has become an important issue f or advocacy groups and other mental health activists. Two years of exp erience with clozapine in the Texas mental health system have shown th at availability of clozapine in the community is a vital factor for su ccessful use of the drug in hospitals, The authors discuss ways to enc ourage outpatient clozapine programs that are critical to successful t reatment in both the hospital and the community.