The document summarizes the history and development of the Zero Suicide initiative in healthcare from its origins in the US Air Force initiative in the early 2000s. It traces the expansion of Zero Suicide efforts to include crisis call centers, health plans, clinical care frameworks, national strategies in countries like England, Wales, and the US, and international collaborations. The timeline shows how individual programs and whole countries have worked to implement Zero Suicide principles and reduce suicide rates in healthcare systems through coordinated efforts across various parts of the system.

1. Zero Suicide in Healthcare:
An International Declaration & Social
Movement September 21 – 22, 2015
The Timeline

2. US Air Force Initiative
“[At the start] there was a lot of debate about whether or not it
was even possible to reduce suicide through this type of an
effort,” according to David Litts. “A lot of people, including
mental health practitioners, were skeptical. But over a six-year
period, the suicide rate dropped by one-third.”

3. Not a Healthcare Issue?
Prominent suicidologists, argued successfully, albeit
erroneously, that this is not a healthcare issue. They kept
suicide out of the mental health Bible, the DSM, stating,
“suicide is, by definition, not a disease, but a death that is
caused by a self-inflicted intentional action or behavior.”

4. After becoming a finalist for a Robert Wood Johnson
Foundation grant, Don Berwick challenged the HFHS
team to pursue perfection. A nurse staff member
suggested that would mean zero suicide deaths. Within
four years, their death rate had decreased by 75
percent.

5. Prior to 2000, there was little research on crisis call center
effectiveness, and credibility was low. Since 2005,
Link2Health has dramatically increased calls and
capacity, started a Veteran’s hotline, added
chat technology, and introduced best practice
standards now utilized worldwide.

6. Arizona DHS and Magellan Health challenged the
provider network to eliminate health plan suicides. In
2011, Behavioral Healthcare cited a 38% reduction in
deaths, decreased hospitalizations and dramatic
increases in staff confidence.

7. Systems Framework
In 2011, a task force of the National Action Alliance set
out to identify the best practice toolkit of interventions for
clinical care staff. The group was captivated by the
cultural and system changes of the pioneers below, and
designed and published a framework for replication.

8. Lancet: England & Wales MH
Services
Between 1997 and 2006, mental health services
implemented recommendations to improve crisis and
suicide care. While et al concluded that implementing
these recommendations was associated with lower
suicide rates in both cross-sectional and before-and-after
analyses. The provision of 24 hour crisis care was
associated with the biggest fall in suicide rates

9. National Council Magazine
“Suicide Prevention is Everybody’s Business: Not Another
Life to Lose” special edition included the Surgeon
General’s revised US National Strategy, and articles by
more than 50 leaders bridging the suicide prevention
and community mental health fields.

10. Revised US National Strategy
In 2012, the US Surgeon General and the National Action
Alliance published a revised national strategy with new
goals 8 and 9, calling for suicide prevention to become a
“core component” of health care, and for improved
professional and clinical practices, respectively.

11. International Summit
Leaders from New Zealand, the UK, the US and the
Netherlands met at IIMHL in Oxford, UK. Dutch psychiatrist
Jan Mokkenstorm: “We are at the beginning of this
journey and start out from the core value that not one of
our patients should die alone and in despair.”

12. Washington DC Academy
The Substance Abuse and Mental Health Service
Administration (SAMHSA) funds the first cohort of 16
organizations and 48 leaders to develop implementation
plans. Faculty include champions from IFH, Centerstone
America and Group Health. The SPRC organizes and
hosts the event.

13. UK Country-wide Initiative
In January, UK Deputy PM Nick Clegg promised a “Zero
Suicide” campaign of charities, voluntary organizations,
and the NHS in “every part of England.” He referenced
pilots in Merseyside, the east of England, and the
southwest that have employed the Henry Ford model.

14. In June, US News & World Report described the systematic
transformation of the largest non-profit Community Mental
Health Center in the country, Centerstone America, and its
ambitious Zero Suicide protocols which reduced its suicide
death rate 65% in less than two years.

15. Atlanta Declaration
In September, a group of 40 service users from 13 countries,
healthcare providers and government policy makers will
gather in Georgia. The International Initiative for Mental
Health Leadership match will create an international consensus
document and plan for expanding the social movement.

16. Adopt the mindset.
Change the world.
Zero is the only goal
we can live with.
Zero Suicide in Healthcare Atlanta Summit 2015