HEADS-ED: Paediatric Mental Health Assessment for the Emergency Department
Standardised tool for assessing paediatric mental health presentations in the emergency department. Assesses 7 domains: Home, Education, Activities, Drugs/alcohol, Suicidality, Emotions/Behaviour, Discharge resources.
Score interpretation
HEADS-ED 0-5 -- lower acuity; community mental health support may be appropriate if safety confirmed
→ Safety assessment: confirm no active suicidal ideation with plan; written safety plan with child and family; CAMHS urgent referral within 5-7 days; GP notification same day; crisis line numbers (116 123 Samaritans, Childline 0800 1111); family safety net: identify responsible adult; school notification if consent given; document HEADS-ED score and clinical decision in notes; discharge checklist completed.
HEADS-ED 6-9 -- moderate risk; psychiatric liaison assessment in ED required
→ Do not discharge without CAMHS/psychiatric liaison review; place of safety in ED while awaiting review; safety observation (1:1 nursing); involve parent/guardian in assessment; crisis plan development; CAMHS duty team contact urgently; consider urgent outpatient appointment vs admission based on clinical assessment; safeguarding check; if suicidality score 2: immediate psychiatric assessment regardless of total score; document all conversations, including safety plan and capacity assessment.
HEADS-ED 10-14 -- high risk; psychiatric admission strongly indicated
→ CAMHS inpatient or crisis bed referral; child and adolescent psychiatry immediate review; do not leave child unattended; parent/guardian to remain; formal mental health act assessment if child lacks capacity or is refusing admission (Children Act 1989 / Mental Health Act 1983 -- age and Gillick competence assessment); MHA section 5(2) holding power if needed; inpatient CAMHS bed identification (NHSE inpatient mental health bed finder); medical clearance investigations: TFTs, glucose, FBC, toxicology screen; safeguarding referral if abuse concerns; document in detail.
Interpretation bands for the HEADS-ED. Apply clinical judgement and local guidance.
References
- Cappelli M et al. The HEADS-ED: a rapid mental health screening tool for pediatric patients in the emergency department. Pediatrics. 2012;130(2):e321-327.
- NICE CG155. Self-harm in over 8s: long-term management. NICE. 2011 (updated 2022).
Related
Curated clinical cross-links plus same-class fallbacks.
- Ibuprofen (Paediatric) · NSAID / Analgesic / Antipyretic
- Hydrocortisone (IV — Paediatric Emergency) · IV Corticosteroid / Adrenal Replacement
- Paracetamol (Paediatric) · Analgesic / Antipyretic — First-Line Pain and Fever in Children
- Morphine (Paediatric) · Opioid Analgesic — Moderate to Severe Pain in Children
- Gentamicin (Paediatric) · Aminoglycoside — Neonatal Sepsis / Gram-Negative Infections in Children
- Vancomycin (Paediatric) · Glycopeptide Antibiotic — MRSA / Severe Gram-Positive Infections in Children
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.