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A summary is presented of the amendment to the civil commitment statute, enacted by the Virginia's General Assembly in 2008.

Studies treatment refusal of antipsychotic medications and associated outcomes in Virginia where psychiatrists have the discretionary power to administer treatment over patients' objections. Approaches to treatment refusal; Methodology and analysis of the study; Treatment refusal outcomes; Implications of the study to policymakers.

Objective: This study sought to identify factors associated with patient treatment referral for electroconvulsive therapy (ECT) by psychiatrists practicing in Virginia., Methods: Psychiatrists (N = 116) were surveyed regarding their knowledge about and attitudes toward ECT. We also inquired into other potential factors that might be associated with referral, such as distance from an ECT provider or availability of transportation., Results: Most psychiatrists had a basic understanding of ECT, and most had a favorable opinion of ECT. However, a lesser degree of knowledge about ECT by psychiatrists correlated with both a less favorable view of ECT and with fewer referrals for treatment with ECT. In addition, physicians who viewed ECT as a "treatment of last resort" referred patients only sparingly. Factors that prevented even those physicians with favorable attitudes toward ECT from referring appropriate patients for ECT included patients' negative attitudes toward ECT, the logistics of arranging support and transportation, and financial constraints., Conclusions: Patient referral for ECT was associated with the treating physicians' and patients' knowledge and attitudes about ECT and with the presence of specific logistical barriers. Attention to these factors by treating physicians might enhance access to ECT treatment.