I've got those options by activating the self-harming choices and picking them whenever I could, I guess. I'm not entirely sure. I explored a LOT of options and combinations and ended up finding that particular one out of curiosity.
I do remember the moment, though. When the woman (I think she’s the guardian) gives you a tour of the place, I tried to break my character’s arm with the wheelchair wheel, and she got super worried... that might lock you out of the suicidal choice. But it happens during that scene.