Virginia appears to be the first state to commit itself to statewide implementation of psychiatric advance directives, and its experience may be highly instructive for other states. The project began with consensus building among stakeholders (2007-2009), followed by revisions to Virginia's Health Care Decisions Act (2009-2010) and designation of five of the state's 40 Community Services Boards as demonstration sites for facilitation efforts. Early implementation efforts quickly showed that psychiatric advance directives are not self-executing innovations. This column describes the early policy and practice innovations, lessons learned from initial implementation efforts, and three approaches to facilitating completion of advance directives by consumers.

Richard J. Bonnie, Kathleen Kemp & Heather Zelle, Advance Directives for Mental Health Care: Innovation in Law, Policy, and Practice, 66 Psychiatric Services 7 (2015).