Non adherence in patients with schizophrenia is common, often difficult to detect and even more challenging to manage.. Although LAIs are most effective way to address this problem and reduce relapse/rehospitalisation, they remain largely underutilized in clinical practice, even as the evidence indicating their effectiveness early in the course of illness increases. There are several reasons for such recalcitrance, including meta-analyses which seem to indicate only modest long-term benefits following the use of LAIs. Considerable disagreement also exists with regard to how long should streatment continue, with 5 years relapse-free survival being proposed as the threshold for discontinuing antipsychotics. This symposium primarily addresses the reasons, adverse consequences in terms of chronicity, and remedies for such recalcitrance. It will also focus on pragmatic clinical guidelines to help in LAI selection, along with issued related to cost-effectiveness. Barriers to the use LAIs in real-life practice, strategies for meeting such challenges and ways of helping patients, carers and family members in making an informed choice will be discussed. Recent advances in the pharmacology of LAIs, as also the controversies surrounding these will be considered. While narrating the Australasian experience, the focus remain on the wider implications of the issues involved. Future directions will be outlined, including the advent of 3-monthly paliperidone injection and the US FDA approval for the 6-monthly preparation..