TRS ACCESS Network · 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.

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.

Massachusetts General Hospital building 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
1 in 3
of people with schizophrenia

Meet criteria for treatment resistance

Across 50 studies, the estimated prevalence of TRS was 36.7%.

Schizophrenia Research, 2023
Global use in 2024
66 of 75
countries studied

Clozapine use was below the estimated level of need

Use was below 0.10% of the total population, while an estimated 0.20% may be eligible for clozapine.

The Lancet Regional Health – Europe, 2026

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 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

Oliver Freudenreich, MD

Professor of Clinical Psychiatry, Harvard Medical School

Co-director, MGH Psychosis Clinical and Research Program

Oliver Freudenreich directs TRS ACCESS and leads its consultation service for clinicians managing complex psychosis.

View publications
Abigail Donovan

Abigail Donovan, MD

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

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

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

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

Marta Hernandez

Program Coordinator

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

Leah Namey

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

MGH Psychosis Clinical & Research Program

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

Teaching & Talks

Invite our faculty to speak with your team

Our faculty are available to deliver Grand Rounds, lectures, case conferences, and educational presentations on schizophrenia, clozapine, long-acting injectables, and related topics. We welcome invitations from academic medical centers, hospitals, community clinics, residency and fellowship programs, and professional organizations.

Request a talk

Please contact us with the proposed date, audience, format, and topic you have in mind.

Resources

Educational materials and publications from our faculty

Selected Publications

Clozapine Monitoring: Form Follows Function

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

Argues that the end of the clozapine REMS program is an opportunity to redesign monitoring so that medical follow-up tracks a clinical treatment framework with three phases: clozapine trial, treatment optimization, and treatment consolidation.

View Article

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

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

A mixed-methods study of real-world adoption of a point-of-care fingerstick device for neutrophil monitoring at two outpatient clinics, finding that successful implementation depends on addressing patient preferences, staffing logistics, and sustainable financing.

View Article

Clozapine for Optimal Schizophrenia Care: A Mission-Critical Medication

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

A conceptual review supporting earlier, routine clozapine use in TRS within a stage-based treatment framework, including strategies for safe use and overcoming barriers to access.

View Article

Books by Our Faculty

Psychotic Disorders: A Practical Guide

by Oliver Freudenreich, MD

Second Edition - A comprehensive guide to understanding and treating psychotic disorders in clinical practice.

View book

Facing Serious Mental Illness

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

A guide for patients and families dealing with serious mental illness.

View book

Substance Use and the Acute Psychiatric Patient

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

Emergency Management - A comprehensive guide for managing substance use in psychiatric emergencies.

View book

Suicide by Security Blanket

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

And Other Stories from the World of Emergency Psychiatry.

View book

Educational Videos

Secondary Psychosis

Oliver Freudenreich, MD discusses secondary psychosis and differential diagnosis considerations.

Oliver Freudenreich Diagnosis

Schizophrenia: Causes, Symptoms, Risk Factors

Abigail Donovan, MD explains the spectrum of schizophrenia, covering causes, symptoms, and treatment approaches.

Abigail Donovan Education

TRS Overview

Educational presentation on TRS and clozapine treatment approaches.

TRS Clozapine

Clinical Research in Psychosis

Research seminar discussing current clinical research initiatives in psychosis treatment and management.

Research Clinical

Contact TRS ACCESS NETWORK

Get in touch with our specialized team

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