Treatment using Clozapine has not been implemented adequately within Japan, but under the Medical Treatment and Supervision Act, it has become widely used. As such, it has become one of the go-to methods of treatment used under this act. Mentally disordered offenders, who are typically difficult to treat as a result of "multiple disabilities" like, Treatment-Resistant Schizophrenia (TRS) with a comorbidity like an Autism Spectrum Disorder, or an Intellectual Disability, or a Personality Disorder, or a Substance-Related Disorder, we proactively treat with Clozapine with an eye towards transitioning them from inpatient to community care.
 In the case of a TRS, psychosocial support is important in addition to antipsychotic medication. Treatments using Clozapine will achieve a better and longer treatment alliance. Performing psychosocial support under the Medical Treatment and Supervision Act, we have recognized the importance of Shared Decision Making in combination with a Crisis Plan, while also implementing skill-training for the patients in order to improve day-to-day skills as a protection against violent risk. This, in turn, will lead them to safely live within the community. This is not limited to just treatments used under the Medical Treatment and Supervision Act, but can be applied to ordinary psychiatric treatment wherein we can implement psychosocial support via a Multi-Disciplinary Team for patients with severe mental illness in community care.
 It is our hope that the early and appropriate decision to implement treatments using Clozapine in combination with psychosocial support that targets community care under the Medical Treatment and Supervision Act, will promulgate the reform of the Mental Health Services within Japan.
 Authors' abstract