Professor Jo Smith

12 Smith

In 2014, Professor Jo Smith attended the two-day suicide prevention “match” meeting in Oxford that was part of the week’s International Initiative for Mental Health Leadership (IIMHL) activities, culminating in a large group exchange of over 500 leaders in Manchester on Thursday and Friday.

It was at this meeting that she took an interest in a small group of 15 from New Zealand, the Netherlands, Northern Ireland, the UK, and the United States who were networking around the Zero Suicide in Healthcare agenda. She coached them and provided her experience in bringing first break psychosis early intervention services to scale in the United Kingdom.

“Antagonism and resistance are your friends in mobilizing a movement.” She shared the original declaration they had developed years ago, which begins “imagine a world where….” She explained they borrowed the format almost directly from innovators creating similarly “impossible” goals around diabetes care years earlier.

Jo instructed us on the stages of similar movements:

  • A “burning platform” that intensifies dissent
  • Main stream adoption
  • A national program and stronger investment, with research and validation running parallel as the model is refined and perfected
  • Documented outcomes

“People change what they do less because they are given analysis that shifts their thinking than because they are shown a truth that influences their feelings,” she said, and it resonated.

Just over a year later in 2015, she would facilitate the second Zero Suicide International summit in Atlanta, and utilize the declaration model to catapult the movement forward.

Bold Goals: A Blue-Sky Declaration


Professor Smith inspired the Atlanta contingent in 2015 to do what two other sets of pioneers had done before. Shift the paradigm. Set aside incremental change. Form a mindset that will lead to frame-breaking results.

The first major paradigm shift began with diabetes care in 1989. The St. Vincent Declaration introduced the new idea that people with diabetes would be “co-responsible for their treatment.” It was created by a small group consisting of individuals with diabetes, government policy makers, and healthcare providers, all of whom met in a remote Italian village.

The St. Vincent group established “ambitious targets intended to kick-start governments and healthcare services into action – addressing issues in an orderly and effective way.” Their intention was to educate key stakeholders about innovative treatment options and create strong collaborative relationships between service users and their healthcare professionals. It was a watershed moment in diabetes care.

The second paradigm shift came with the Newcastle Declaration on early intervention services for psychosis in 2002.

In 2015, early intervention services for first break psychosis were beginning to emerge around the world, but much of this development began with a small group of pioneers who gathered in Cheltenham in the UK in 2001. Their ideas inspired the National Institute for Mental Health in England to host a 2002 meeting in Newcastle of 40 individuals (including service users, family members, and healthcare providers), the World Health Organization (WHO), IRIS (the Initiative to Reduce the Impact of Schizophrenia), and Rethink.

Their basic premise seemed outrageous at the time: young people who have a first psychosis and their families should be supported to achieve an ordinary life and quickly move beyond a diagnosis to recovery. This bold proclamation received international recognition in 2004, when the WHO Director of Mental Health, Benedetto Saraceno, shared the document. It was soon endorsed by the International Early Psychosis Association.

Professor Smith told a small group in 2014 that she believed the next ground-breaking paradigm shift might very well be Zero Suicide.

On September 21 and 22, 2015, fifty-two individuals from 13 countries convened at the Capital City Club in Atlanta, Georgia to jointly craft an International Declaration for Zero Suicide in Healthcare. Professor Smith facilitated the meeting, utilizing the same successful format as the St. Vincent and Newcastle Declarations.

“International declarations that articulate core values, goals, and standards have played an important role in enhancing the quality of care in a number of areas of medicine,” begins the 2005 British Journal of Psychiatry review of the second-generation effort led by David Shiers and Jo Smith.

The purpose of the Atlanta IIMHL match meeting was to complete a document that might influence all the nation states with a comprehensive suicide prevention plan to adopt the principles that will make suicide care a central focus for behavioral health and integrated healthcare systems.

It was also designed to fan the flames of an emerging social movement related to Zero Suicide in Healthcare. Misconceptions abound, and the document was the first attempt to spell out the framework and ambition for an international audience: what it is, what it is not, and how it began.

Download The International Declaration for Better Healthcare: Zero Suicide (viewed nearly 20,000 times)