Massachusetts General Hospital · Harvard Medical School

Expert support for treatment-resistant schizophrenia care

We help clinicians and health systems deliver timely, safe, evidence-based care—through consultation, education, and hands-on implementation support, so people get the right care from their own providers.

For clinicians Request a clinical consult For health systems Ask about implementation support

MGH Department of Psychiatry

TRS ACCESS Network

Building a network of clinicians and health systems to expand access to evidence-based TRS treatment

TRS ACCESS supports clinicians and health systems caring for people with treatment-resistant schizophrenia (TRS). ACCESS reflects how we work through Advocacy, Clinical Consultation, Education, and Support Services.

We help health systems and providers expand safe, effective use of clozapine—the only FDA-approved medication for TRS—and long-acting injectable antipsychotics.

Courtesy of Oliver Freudenreich

The TRS ACCESS Network is supported by the generous philanthropy of the CNR Foundation.

Evidence at a glance

The treatment access gap

TRS is common, but clozapine remains rarely used.

Clinical need

About 1 in 3 people with schizophrenia-spectrum disorders in the reviewed studies had treatment resistance.

Based on a review of 50 studies.

Brazilian Journal of Psychiatry, 2023

U.S. health systems

<2% of potentially eligible patients started clozapine within one year.

Adults with psychotic disorders across 11 U.S. health systems (2019 data).

Journal of Clinical Psychiatry, 2024

Global use in 2024

66 of 75 countries had estimated clozapine use below half the authors’ benchmark for potential need.

Estimates for people aged 15+, based on medication-volume data.

Study details

Estimated use was below 0.10% of the population aged 15+ in these countries, compared with the authors’ 0.20% benchmark for potential need. These are population-level estimates, not a direct count of eligible patients treated.

The Lancet Regional Health – Europe, 2026

Why timing matters

Longer delays before starting clozapine have been associated with a poorer response once treatment begins.

Delay may also mean years of ineffective treatment, recurrent relapse and hospitalization, accumulating disability and caregiver burden—while postponing access to a treatment shown to reduce suicidal behavior and associated with lower mortality.

Delayed initiation review, 2018 Rehospitalization study, 2023 Suicide prevention trial, 2003 Mortality study, 2019

Understanding TRS ACCESS Network

Abigail Donovan, MD explains our mission

Learn how TRS ACCESS helps clinicians prescribe clozapine and long-acting injectables safely and effectively for people with TRS.

Nauset Light lighthouse at golden hour, Cape Cod

Courtesy of Oliver Freudenreich

A lighthouse is a beacon of hope in a sea of uncertainty.

Our Mission

Clozapine is proven to be the most effective treatment for TRS, but many people never receive it. The TRS ACCESS Network exists to close this gap by supporting earlier, safer, and more consistent use of clozapine and other best-practice interventions.

What We Do

We partner with clinicians, clinics, and health systems to:

Support implementation of clozapine and long-acting injectable antipsychotics
Educate providers and care teams on evidence-based TRS treatment
Consult on clinical care for people with TRS

Our Approach

We combine advocacy, consultation, education, and hands-on support to remove barriers to effective TRS care—prioritizing safety, adherence to best practices, and solutions tailored to local needs.
We are building a collaborative network of expertise that connects specialists with local providers to ensure best practices reach every person who needs them.

Our Impact

Timely access to effective treatments improves outcomes—relapses decrease, lives stabilize, and recovery becomes more achievable.
Early identification and proactive management of side effects help protect long-term physical and psychiatric health.
By treating the whole person—not just symptoms—we support lasting wellness and a better quality of life.

Provider & System Benefits

Education and support empower clinicians to deliver the highest-quality, evidence-based TRS care—treatment that can transform lives.
High-quality TRS treatment reduces Emergency Department visits and hospitalizations, resulting in more effective care at a lower overall cost to the health system.

Why Outcomes Matter?

Abigail Donovan, MD explains the importance of improving health outcomes

Measuring and improving outcomes for people with TRS can transform lives and healthcare delivery. Our focus on outcome-based care helps ensure that every intervention leads to meaningful improvements in well-being and recovery.

Our Team

Expert clinicians dedicated to TRS ACCESS services

Oliver Freudenreich, MD

Director, TRS ACCESS Network

Professor of Clinical Psychiatry, Harvard Medical School

Co-director, MGH Psychosis Clinical and Research Program

Oliver Freudenreich leads the consultation service for clinicians managing complex psychosis.

View publications

Abigail Donovan, MD

Associate Director, TRS ACCESS Network

Assistant Professor of Psychiatry, Harvard Medical School

Director of Clinical Services, MGH Psychosis Clinical and Research Program

Abigail Donovan specializes in early detection, treatment, and quality improvement for schizophrenia care.

View publications

Carol Lim, MD, MPH

Assistant Professor of Psychiatry, Harvard Medical School

Medical Director, MGH Clozapine Clinic

Carol Lim directs the MGH Clozapine Clinic and helps health systems establish safe clozapine monitoring programs.

View publications

Sarah Maclaurin, PMHNP-BC

Psychiatric Nurse Practitioner & LAI Specialist

Sarah Maclaurin provides clinical care, consultation, and training focused on long-acting injectable antipsychotics.

Cheryl Foo, PhD

Assistant Professor of Psychology, Harvard Medical School

Clinical Psychologist & Implementation Specialist

Cheryl Foo leads implementation support for safe, effective clozapine and long-acting injectable services.

View publications

Marta Hernandez

Program Coordinator

Marta Hernandez coordinates program activities and supports patient care and daily operations.

Leah Namey, MPH

Program Manager

Leah Namey manages TRS ACCESS operations and quality improvement initiatives.

Our Services

Comprehensive support for evidence-based TRS care

Clinical

Direct clinical services and case consultation

Clinical Consultation

Expert consultation for clinicians managing complex cases of difficult to treat psychosis, providing guidance on diagnosis, treatment planning, and clozapine initiation and management.

Oliver Freudenreich, MD on consultation services

Request a clinical consult Explore consultation service

MGH Psychosis Clinical Services

The TRS ACCESS Network is part of the MGH Psychosis Clinical and Research Program (PCRP), which provides comprehensive clinical care for patients with psychotic disorders.

MGH PCRP provides care across all stages of illness:

Community partner

Implementation Support and Technical Assistance

Helping clinics and health systems build the capacity to deliver safe, effective TRS care

Development of Clozapine-Capable Clinics

We specialize in optimizing clozapine treatment, navigating today's regulatory landscape to ensure safe, effective prescribing. Our support includes protocol development, staff training, and education to uphold best practices in clozapine management.

Carol Lim, MD on clozapine clinic services

Development of Long-Acting Injectable Clinical Services

Training and consultation on long-acting injectable antipsychotic medications, helping clinicians optimize medication adherence and improve treatment outcomes.

Sarah Maclaurin, PMHNP-BC on LAI expertise

Program Implementation

Implementation support to help healthcare systems and clinicians become capable of prescribing clozapine and long-acting injectable safely and effectively, including staff training, workflow development, and ongoing support.

Cheryl Foo, PhD on program implementation

Global Collaboration

Uganda Psychosis Care Collaborative

MGH TRS ACCESS Network and Makerere University collaboration advancing schizophrenia and clozapine care in Uganda

Explore the collaboration

Invite a Speaker

Our faculty offer practical teaching on schizophrenia care, including TRS, clozapine, and long-acting injectable antipsychotics.

Planning Grand Rounds, a lecture, a case conference, or another educational session? Tell us about your audience and what you would like to explore. We welcome requests for other topics and formats.

Request a talk

Resources

Educational materials and publications from our faculty

Featured Clinical Guide

MGH PCRP Clozapine Care Framework(Post-REMS Era, 2026)

Clinical guide · PDF

Evidence-based clinical guidance from the MGH Psychosis Clinical and Research Program.

View / Download PDF

Selected Publications

Clozapine Monitoring: Form Follows Function

A framework for organizing clozapine monitoring across the trial, optimization, and consolidation phases.

Donovan AL, Foo CY, Lim C, MacLaurin SA, Freudenreich O. Psychiatric Services. 2026;77(5):470–473.

View Article

Implementing Point-of-Care Fingerstick Testing for Clozapine Safety Monitoring in Outpatient Psychiatry: A Convergent Mixed Methods Study

Practical lessons for introducing point-of-care fingerstick monitoring in outpatient clinics, including patient preferences, staffing, and financing.

Foo CYS, Lim C, Leonard CJ, MacLaurin SA, Cather C, Donovan AL, Freudenreich O. Community Mental Health Journal. 2026.

View Article

Clozapine for Optimal Schizophrenia Care: A Mission-Critical Medication

A review supporting earlier clozapine use in TRS, with practical strategies for safe treatment and overcoming barriers to care.

Lim C, Freudenreich O. Korean Journal of Schizophrenia Research. 2025;28(2):29–38.

View Article

Books by Our Faculty

For clinicians

Psychotic Disorders: A Practical Guide

by Oliver Freudenreich, MD

A practical guide to understanding and treating psychotic disorders (second edition).

View book

For patients & families

Facing Serious Mental Illness

by Oliver Freudenreich, MD, Corinne Cather, PhD, and Theodore A. Stern, MD

Guidance for navigating the challenges of serious mental illness.

View book

For clinicians

Substance Use and the Acute Psychiatric Patient

by Abigail L. Donovan, MD and Suzanne A. Bird, MD

A guide to managing substance use in psychiatric emergencies.

View book

Emergency psychiatry stories

Suicide by Security Blanket

by Laura M. Prager, MD and Abigail Louise Donovan, MD

Stories offering a window into the world of emergency psychiatry.

View book

Educational Videos

Secondary Psychosis

Oliver Freudenreich, MD explains how to assess possible causes of secondary psychosis.

For clinicians 29 min 23 sec

Schizophrenia: Causes, Symptoms, Risk Factors

Abigail Donovan, MD introduces schizophrenia, its symptoms, and treatment approaches.

For patients & families 4 min 32 sec

Community Psychiatry: Progress and Challenges

Oliver Freudenreich, MD discusses progress and challenges in community psychiatry at MGH Schizophrenia Education Day.

For patients & families 39 min 2 sec

Call to Action: Why I Am Hopeful

Oliver Freudenreich, MD calls for better care for people facing both mental illness and cancer.

For clinicians & care teams 19 min 13 sec

Contact TRS ACCESS NETWORK

Get in touch with our specialized team

Address

151 Merrimac St, Suite 401
Boston, MA 02114

Phone

617-643-1175

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