Expanding Clozapine Use in State Prisons: A Review of the North Carolina Experience

The prevalence of serious mental illnesses in prisons is estimated to be significantly higher than in the community. The antipsychotic medication clozapine is very effective in managing treatment-resistant psychosis and may also reduce suicidal and self-injurious behaviors but is underused due to several logistic challenges. A partnership between the North Carolina prison system and University of North Carolina School of Medicine established a consultative system for clozapine initiations that has led to a 390% increase in the number of incarcerated people using clozapine over a 5-year period. This article reviews the benefits and challenges of clozapine use in corrections based on the North Carolina experience and practical strategies on how to expand use in a prison system.