Treating Unmet Needs in Psychiatry (TUNE-UP): targeted service increases out-patient initiations of clozapine

Journal article

Background: In the UK, clozapine is the only licensed treatment for treatment-resistant schizophrenia (TRS). However, it is underused because initiation is often limited by the need for in-patient admission, which is costly and unattractive to patients. Community clozapine services may address this. Aims: To describe a targeted out-patient clinic (Treating Unmet Needs in Psychiatry (TUNE-UP)) for TRS management and assess its impact on community clozapine initiation rates. Method: We reviewed clozapine titrations of patients under four community mental health teams from September 2021 to January 2025, recording whether titration occurred as in- or out-patient. The TUNE-UP clozapine clinic operated for 12 months (September 2023 to September 2024). Initiation rates during the TUNE-UP period were compared with those when the service was unavailable, using Poisson regression. Clinical outcomes were assessed using scales including the Positive and Negative Syndrome Scale (PANSS). Results: Fifty-one individuals commenced clozapine during the study period. There was a significant increase in the rates of community initiation in the TUNE-UP period (11.0 per year) compared with those outside of this period (1.71 per year; incidence risk ratio 6.42 [95% CI 2.04–20.2, P = 0.0015]). Patients seen by TUNE-UP showed significant improvements in PANSS (n = 6, median improvement 21.5 [95% CI 7.0–33.0], P = 0.03). Conclusions: A specialist service was associated with a significant increase in community clozapine initiations. This approach offers a strategy to improve TRS treatment in the community.

Authors: Ahmad Khan, Z; Varvari, I; Mancini, V; Zita-Zauchenberger, C; Kantor, S

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Cambridge University Press
• Journal: BJPsych Open
• Volume: 12
• Issue: 2
• Article number: e73
• Publication date: 2026-02-26
• Acceptance date: 2026-01-20
• DOI: 10.1192/bjo.2026.10988
• EISSN: 2056-4724
• ISSN: 2056-4724
• Language: English
• Keywords: out-patient treatment; Psychotic disorders/schizophrenia; general adult psychiatry; community mental health teams; antipsychotics