Autokabalesis is a method of severe deliberate self-harm (DSH) involving jumping from a height. It has been presented in a study that this form of attempting suicide was done predominantly by single, young unemployed males. Also, it appears that patients who have acted in this dangerous manner had serious psychiatric disorders. In this article a fascinating case of a patient who developed psychosis due to his increased anxiety egodystonic related thoughts with paedophilic context which led him to a serious suicidal attempt. The difficulties in managing this case in a trauma ward by different teams are discussed. The challenges and the ways that could be used to overcome this in one of the busiest London hospitals.