In 2009, the Virginia General Assembly enacted major amendments to the Commonwealth's Health Care Decisions Act (HCDA). The revisions were based on recommendations of the Supreme Court's Commission on Mental Health Law Reform, which had solicited extensive input from and involvement of a broad spectrum of stakeholder groups during a two-year period of deliberation and drafting (Bonnie et al., 2009). Because of the statutory revisions enacted in 2009 and 2010, the HCDA now provides a legal mechanism for persons with chronic health conditions, including serious mental illness (SMI), to document, while competent, their treatment instructions and preferences, and to authorize a healthcare agent to make treatment decisions for them during periods of incapacity, These advance directives may also contain individualized, patient-centered plans to prevent crises, as well as to manage and recover from them.

Richard J. Bonnie, Use of Advance Directives by People with Serious Mental Illness under Virginia’s Health Care Decisions Act: Implementation of a Major Public Health Reform: Project Overview: December 31, 2010, Developments in Mental Health Law 9–12 (2011).