In my state, clients of mine who don't take the drugs are then placed on involuntary holds and after a court hearing will be civilly committed for about a month (the statute gives the time frames) during which they are forced to take them. ECT can only be given with the person's consent or after an evidentiary hearing (where attys like me represent them) and court order. I have found it depends upon the hospital/staff as to how quickly the situation is escalated. The laws in terms of timing and extent vary from state to state and the treatment of my clients is very facility/staff variable.