In the UK, the coroner (or procurator fiscal in Scotland) will only return a verdict of suicide if
suicidal intent can be proved beyond reasonable doubt. Suicidal intent is not a static concept and
changes with time. Among psychiatric inpatients (including older people), suicides are higher in
patients who have f luctuating suicidal intent than in those whose intent does not f luctuate. The
issue of intent becomes even more complex in elderly patients who, although not overtly expressing
a desire to kill themselves, have hidden intent. This paper describes these concepts and reviews
assessment and management options.