Grant: CIHR Fellowship

Severe mental illnesses such as schizophrenia and bipolar disorder are vastly overrepresented among offender populations worldwide. Treatment with antipsychotic medication is the cornerstone of therapy for these conditions. However, adherence to these medications is a well-established challenge, complicated by often severe side effects. Previous research has found that antipsychotic medications are heavily prescribed while prisoners are in custody, but that their ongoing use is frequently disrupted during the transition from custody to community settings. Low adherence leads to an increased risk of relapse and repeat involvement with the justice system. Clinical trials of clozapine - often known as the gold standard of therapy - and long acting injectable antipsychotic drugs have shown particular promise for improving outcomes. However both are under-utilized. The proposed study is the first of its kind to investigate the impact of clozapine and long acting injectable antipsychotics in a very large sample (>250,000) of offenders. The study is supported by the School of Social Welfare at the University of California Berkeley - one of the world's leading centres investigating the interface of serious mental illness and crime. Data will be drawn from a large database created in the province British Columbia (BC), Canada, which links comprehensive justice and pharmaceutical details for the entire population of BC. These administrative data will be supplemented with clinical details drawn from hospital charts in California. This research is expected to produce findings that guide improvements in the safety and effectiveness of treatments using antipsychotic medication for mentally ill offenders. Findings may also extend to opportunities for improved prescription practice among non-offenders with severe mental disorder.