Self-strangulation should be cautiously determined following a comprehensive death investigation because the circumstance of strangulation is usually homicide. The deceased was a 33-year-old male who suffered from depression and was found missing from a psychiatric unit while on treatment. The deceased was found the following day in the doctors’ car park of the unit. The deceased was in a prone position with a strip of material from the sarong he was wearing round his neck and features of strangulation. Scene investigation and autopsy with the history of psychiatric disease confirmed self-strangulation. The rarity of self-strangulation, especially in a hospital, and the ligature material used being a strip of material from the sarong he was wearing inspired us to report this case.