The report indicates that many people receive more aggressive care than they desire at end-of-life and that advance directives are under used, with only 18% to 36% of adults having completed the document. "Whether persons with mental illness have the capacity to engage in advance care planning and complete an advance directive is controversial. " <http://aspe.hhs.gov/daltcp/reports/2008/ADCongRpt.htm>http://aspe.hhs.gov/daltcp/reports/2008/ADCongRpt.htm "People Who experience mood swings, fear, voices and visions"