Clozapine is an antipsychotic medication found to have greater efficacy than other antipsychotics for individuals who have treatment-resistant psychosis. In North Carolina, only 2% of people treated with antipsychotic medication receive clozapine, while it is estimated that up to ten times more individuals would benefit from it.
Clozapine can cause a rare but very serious side effect called agranulocytosis—a drop in white blood cells that occurs in 1% of the individuals treated with it so its use must be frequently and carefully monitored. Consequently, physicians often shy away from prescribing the drug.
We developed strategies to overcome barriers in the medical community to clozapine use, would people with difficult to treat psychosis have a better chance at managing their illness?
A unique blend of public/private entities including: Dr. Brian Sheitman and the CECMH staff; the N.C. Division of Mental Health, Developmental Disabilities and Substance Abuse Services; Central Regional Hospital; Dorothea Dix Hospital; the Department of Psychiatry of Duke University; and Orange Person Chatham Local Management Entity (OPC LME).
NOTE: Funding for this pilot project is coming from the N.C. Division of Mental Health, Developmental Disabilities and Substance Abuse Services.
Many of our nation's people living without housing have severe mental illness. But it's anyone's guess how much of that is by choice rather than being due to illness-related factors or larger, system-wide issues. For example, many factors can play a role, including disorganization, cognitive deficits, poor impulse control, paranoia, burnout or alienation of family, deinstitutionalization, and lack of adequate low-income or supported housing, or residential treatment services.
NAMI's Housing Fact Sheet states, "According to a 1999 HUD report, nearly 40 percent of the nation's homeless are single adults with severe mental illnesses. In addition, a new report "Priced Out in 2000" reports that SSI income amounts to only 18.5 percent of median income nationally and that the average rent for a modest, one-bedroom apartment consumes, on average, 98 percent of a person's monthly SSI check." (http://www.nami.org/Template.cfm?Section=Issue_Spotlights&Template=/TaggedPage/TaggedPageDisplay.cfm&TPLID=5&ContentID=15943)
An exciting resource in use in many states is SAMHSA's Stepping Stones to Recovery: A training curriculum for case managers assisting adults who are homeless with Social Security Disability and Supplemental Security Income Applications. This process is designed to reach people who really need income support and the services it affords, but are unlikely to be able to access it without help. In North Carolina, this effort is called NC SOAR and is coordinated by the North Carolina Coalition to End Homelessness, www.ncceh.org.
Click here to read more about housing options for people with severe mental illness.
Founded in January 2009, the Center for Excellence in Community Mental Health is part of the Department of Psychiatry in the School of Medicine at the University of North Carolina at Chapel Hill. Addressing quality of care and workforce development issues in North Carolina's mental health system, the Center and its clinical programs are supported by a three-year grant from The Duke Endowment, as well as Cross Area Services Program (CASP)
funds. The program operates in conjunction with multiple university, state, and community-based partners.
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