OBJECTIVE: Psychiatric advance directives (PADs) allow individuals to plan for future mental health treatment. However, little is known about barriers to PAD completion. This paper examines an intervention's effect in reducing barriers to PAD completion. METHOD: Patients were randomly assigned to a facilitated PAD session or control group. Barriers associated with (1) the PAD documents and (2) external support for PADs were assessed at baseline (n = 462), 6 months (n = 380) and 1 year (n = 362). RESULTS: There were no significant baseline between-group differences on the two barriers. However, at follow-up both barriers were significantly lower in the experimental group. Further, barriers were predictive of PAD completion. CONCLUSIONS: Structured facilitation can significantly reduce barriers to PAD completion. However, the intervention did not eliminate barriers. Findings are discussed in the context of possible system-level changes to further reduce barriers to PAD completion.