For people with serious mental illness, research demonstrates the potential positive effects of having an advance directive with specific instructions for mental health care. The Commonwealth of Virginia has undertaken efforts to incorporate completion of psychiatric advance directives into routine mental health services for individuals with serious mental illness. The following sequence of three articles aims to acquaint specialists in mental health law, health services research, and policy implementation research with the Virginia Advance Directive Project. The first describes the origins and structure of the Project, including the legislative history and content of the law, and the multi-stakeholder structure created to implement it. The second article identifies the innovations that were needed to translate the opportunity created by the law into routine practice on a statewide basis. The third article describes the barriers to statewide implementation that have been encountered during the first three years of the project.
Richard J. Bonnie, Kathleen Kemp & Heather Zelle, Embedding Advance Directives in Routine Care for Persons With Serious Mental Illness: Implementation Challenges, 66 Psychiatric Services 10–14 (2015).