Traumatic amputations involving the upper limb can be a catastrophic injury with significant short and long-term consequences for patients. Upper limb injuries can have a profound impact of patient's quality of life and have a large impact in the patient's ability to perform activities of daily living (ADLs). A rare cause of traumatic amputations is major self-mutilation. Major self-mutilation is usually a devastating complication of severe mental health issues, with most people who inflict major self-mutilation having a psychotic disorder. We present a case of a self-inflicted traumatic hand amputation associated with an acute psychotic episode. The case shows the difficult decision that has to be made whether to perform a replantation or not. It also discusses gaining consent in a psychotic patient. The case highlights how timely communication between different medical specialists and sites can lead to good outcomes for patients.