Clozapine, suicide prevention and risk perception in psychiatry

Clozapine remains the most effective treatment for treatment-resistant schizophrenia and one of the few psychiatric medications consistently associated with reduced suicidal behaviour. Nevertheless, its use remains markedly limited despite advances in pharmacovigilance, haematological monitoring and individualised prescribing strategies. This editorial examines whether psychiatry may continue to evaluate clozapine through historically inherited models of risk perception that emphasise treatment-attributable mortality while insufficiently incorporating the lethality of severe mental illness itself, particularly suicide. Clozapine therefore represents not only a psychopharmacological treatment, but also a revealing case study in how psychiatry conceptualises competing forms of mortality.