Background: Clinical guidelines recommend the provision of good quality psychosocial assessments and aftercare following an episode of self-harm, and to avoid use of risk scales to predict repetition or to determine patient management. Aims: To overview evidence and current practice on clinical prediction, assessment, and aftercare in England. Methods: Data will be presented from several studies that were conducted using a variety of designs and that have entailed quantitative assessment of diagnostic accuracy and qualitative thematic analyses. Results: Contrary to clinical guidelines: (1) risk scales are widely used in England and have poor predictive performance for self-harm repetition and suicide; (2) receipt of psychosocial assessments is variable in access and quality; and (3) patients and staff experience multiple barriers to accessing evidence-based aftercare. Conclusion: Likelihood of receiving clinically recommended care following self-harm presentations to emergency departments is low and highly variable across service providers. Our findings highlight important gaps between evidence, policy, and practice for people who have self-harmed. Consistent with clinical guidelines, risk scales should not be used to predict repetition or to determine patient care, and all patients should be offered a psychosocial assessment and aftercare following a self-harm episode.