3) Strategy Summary:
Include our self-help groups in the official treatment for depression because there are many loose ends in the actual system. A world authority in depression says treatment is three dimensional: medication, psychotherapy and self-help groups. There are advantages for all the elements involved: the Social Security, the industry, the private sector and the professionals. We are all interested in the health of the patient. He is the protagonist, the tax payer, the consumer and the voter.

We have been working with self-help groups for 10 years with 7000 people and their families and friends and we have proved that it works. Now we want the Health Authorities to take notice of this fact and realize that it improves health care for the patient

4) How the Strategy Works:
First step: The strategy is to sit all the parties interested around a table to discuss the advantages or disadvantages of the idea. Here are de guests:

1. The Pharmaceutical Industry, represented by their association Farmaindustria (in Spain).

2. The Medical Association, in Spain called Colegio de Medicos for psychiatrists and general practitioners.

3. Someone representing the Health Authorities and Social Security. In Spain de Social Security covers most of the expenses in the treatment of depression. Medicines are partly paid by the patient except for people in retirement.

4. The Patient's Advocate. In Madrid she is Margarita Retuerto, good friend of Alianza para la Depresion and very active.

5. Someone representing the Clinical Psychologists or well known professionals.

6. And someone representing the non-profit Patient s Association.

When we heard of the Ashoka contest we were already involved in preparing this summit; in fact, we have a couple of Foundations interested in the matter.

Second step: The media are in the waiting list, ready to start when we have news for them which will be soon, before, during and after the summit. We have a call from the main TV channel in Madrid to call them as soon as we have organized the meeting.

Third Step: Here is a list of the advantages for each party:

a) Pharmaceutical Industry. There are many advantages in having direct access to the Patient s Association. All ethical and prestigious pharmaceutical companies are interested to know that their products are properly used and to receive feedback from the patients.

We are perfectly aware that they cannot promote their prescription products directly with the patients. It has to be done through the practitioners, but there are many other matters of great interest to the manufacturer of a product to be in touch with the consumer, in this case the patient. To mention just one case, a pharmaceutical company (Eisai Co.) in Japan saw this opportunity and has jumped from rank 6 to rank 2 in a few years.

To give an example, we know of patients that have dropped using a medicine because they had problems with the package of the product.

Also, through our many years of experience we have noted that many patients have the idea that the manufacturers are a bunch of people interested only in making money. We explain in our groups that pharmaceutical companies are mainly interested in the health of the patients and for this purpose they have to make money which is used in great part in research to find more and better products. We also do research work for the pharmaceutical industry having questionnaires answered by the patients.

The Japanese company launched a new product as a result of field work with non-profit partient s associations.

With the only restriction of promoting their prescription drugs there are no other reasons why pharmaceutical companies can not work with patient s associations.

b) The medical associations. There is practically a unanimous opinion among physicians of the convenience of working with the patient s associations. We have a psychiatrist that has been cooperating with us for four years, and our president is a professor of psychiatry and a well known professional writer of several best sellers on depression. Throughout these 10 years we have met many physicians and they all agree on the convenience and the need for the work performed by the self-help groups. We know of only one case of a doctor that was not convinced and it was because he was not well acquainted with the work done by the self-help groups.

If the industry agrees and the ones that are supposed to know more about the case, which are the physicians, we do not see many obstacles or objections in the road to make self-help groups part of the treatment, but there is one important step to take which is to convince the Health Authorities. In Spain, with such a wide coverage by Social Security, this entity represents the largest budget for the government and they do not see with good eyes spending additional funds in the caring of these patients. That is the main reason why we have received very little help from the administration. As a matter of fact, we have only received a meager 1,500 euros from the regional government in these past 10 years. But every problem contains an opportunity or a solution and we have many arguments to solve this obstacle.

It is not a donation or an expense; it is an investment. There is an interesting study done by Cole, Tucker and Freeman, published in the American Journal of Health Promotion, in which the authors state that one dollar invested in associations like ours, four dollars are saved in health expenditures.

Our idea can be replicated by other organizations. We belong to a network called GAMIAN (Global Alliance of Mental Illness Advocary Networks) that includes 57 countries.

5) Key Strategy Elements:

i. Mobilizing Citizen Support:
Citizen support is essential and the political party now in power has the possibility of gaining three million votes (number of depressives now in Spain) and they are experts in mobilizing this support. This is after all and important part of their work. Our Founder and Vice President was recently in an International Meeting of Chronic Illness Patient Associations and in the questions and answers period he proposed that our work should be considered by authorities as part of the treatment for depression and his statement was received by the audience with applause which proves that our idea is widely accepted by the Patient Associations.

ii. Generating Financial and Nonfinancial Resources:
The pharmaceutical industry has already shown great interest in the self-help associations. The fact that medical expenditures are reduced does not affect them. The savings are mostly in visits to the doctors, less admissions in hospitals, less sick leaves, etc. For the pharmaceutical industry the great potential is with the patients that do not follow any treatment at all and represents a large percentage of people suffering from depression and these people prefer going to self-help groups than to the doctor because they do not want people to think they are crazy. We advise them to go to the general practitioner first.

iii. Establishing Relationships with Strategic Partnerships:
What makes this idea attractive is that it does not require a big investment because it has to be done gradually over the years because there are very few self-help groups. In Spain it requires 16 associations like ours to cover the country. At least, one for every Community and that requires time. At least 6 or 8 years, but this is also an advantage because like that we are capable of testing the advantages of these groups and training the moderators to handle the patients and their families. Alianza para la Depresion can be very useful in this regard on account of the number of patients already treated and the experience to train people.

iv. Engaging and Managing Volunteers:
Most of our staff are volunteers and we have 10 years of experience in engaging and managing volunteers, even doctors and psychologists.

v. Developing Information and Spreading the Message:
The main types of spreading the message is through press releases, interviews, TV news and P.R. work. As said before, the media has fully cooperated in the past and will do it more so in the future because the idea is really news for them and that is what they live on. We already have calls from the media asking us to call them when we are ready to start.

6) Increasing Self-sufficiency and Social Impact:
It is obvious that our organization will become self- sufficient and the social impact it will produce. We will be paid by the Social Security System, and if this fails, by the Health Insurance Companies, backed by the Industry and Corporate Foundations, what is known as social marketing.

As we are talking of 3 million people and their families, the impact will be very strong. We calculate the cost per patient 80 euros per month. The length of the treatment is an average of 3 months. 80% of patients recover. The initial investment is about 56,000 euros for the first year. It has to be done gradually starting in Madrid and proceeding step by step to the other 16 regions of the country. If by being only in Madrid we have had a big social impact (7000 patients and thousands of calls from all over) imagine being in the 16 regions of Spain, and it can spread to all countries through organizations like Gamian.

8) Organization Mission and Vision:
Mission: To help 360 million depressives and their families in the world by strengthening patient s associations innovative and original approach that will generate funds and training to those associations. Vision: To help in an effective way depressive patients around the world.

Organization Size:
We have now 6 volunteers and one part-time employee. In three years we will have 4 part-time employees, 2 full-time and 12 volunteers approximately

Looking Forward to the Next Three Years:
In three years we expect 3 more associations like ours in Spain which will triple the capacity of our present association.

Jaime Smith Semprun, Founder and Vice President of Alianza para la Depresi
General Margallo, 27, 1D - 28020 Madrid
Spain
Telephone: 34 91 5703003
Fax: 34 91 5702476
Email: smith@alianzadepresion.com
Web site: alianzadepresion.com

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