[Suicidal ideation with instrumental components at inpatient psychiatric admission or discharge: clinical, ethical and judicial implications and recommendations for action].

backgroundThe treatment of patients who report suicidal ideation if they are not admitted as inpatients or discharged from inpatient treatment, raises clinical, judicial and ethical concerns.

methodsEthical discussion based on a case study and practical recommendations for action based on clinical, ethical and judicial aspects and selective literature search. RESULTS AND

conclusionSuicidal statements of patients can have instrumental components. Suicidal ideation with instrumental components (Swic) can be associated with impulsive actions. Even though risk assessment in Swic may not be reliably achievable, there are clinical indicators for assessing the instrumental components of suicidal ideation. A differentiated ethical analysis can broaden the clinical perspective in treating patients with Swic. Communication with patients with Swic should be empathetic, clear and transparent and must be linked with concrete offers of support. The documentation of the treatment for patients with Swic who are not admitted for inpatient treatment or discharged from inpatient care should at least include: diagnostic assessment, consideration of alternatives, offered support and communication with the patient. In addition to inpatient treatment, there are numerous partial inpatient or outpatient support options for patients with Swic.