Elders who are institutionalized are older, sicker & more likely to have no living family members, factors that place them at risk for suicide. Strengthening & extending existing family roles in supporting the elder who is suicidal & depressed is vital. Expanded knowledge of mental health needs of older adults & their families is critical in suicide prevention. A major step is the recognition of depressive symptomatology & key elements & clues to suicide in the institutionalized elderly.