A National Analysis of Facility-Level Clozapine Availability in U.S. Mental Health Services.

Objective: Clozapine is highly effective but underutilized because of patient-, prescriber-, and system-related factors. The purpose of this study was to describe clozapine availability at U.S. mental health facilities.

Methods: A cross-sectional analysis of the 2023 National Substance Use and Mental Health Services Survey was conducted. Clozapine availability was assessed along with facility characteristics associated with odds of clozapine prescription via logistic regression.

Results: Among facilities that prescribed antipsychotics (N=6,445), clozapine was available at 58% overall and at 64% that had a dedicated serious mental illness program. Psychiatric hospitals had the highest availability (80%). Outpatient facilities (adjusted odds ratio [AOR]=0.41, p=0.004) were less likely to offer clozapine, and those with serious mental illness programs (AOR=1.57, p<0.001), those with on-site laboratory testing (AOR=1.69, p<0.001), and those that accepted Medicare (AOR=1.92, p<0.001) were more likely to offer it.

Conclusions: Limited facility-wide clozapine availability in many settings underscores the depth of its underutilization. Closing gaps in clozapine access will require targeted policy, quality improvement, and educational initiatives.