Heidi Otway Intro: Welcome to the Fluent in Floridian podcast, featuring the Sunshine State's brightest leaders talking about the issues most important to the people of Florida and its millions of weekly visitors. I'm Heidi Altway, president of SalterMitchell PR. In this episode, April Salter, the founder of our firm, is talking with Melanie Brown-Woofter, the president and CEO of the Florida Behavioral Health Association. This nonprofit organization represents community mental health and substance use treatment providers across the state. We are releasing this interview during Mental Health Awareness Month, and we're encouraging you to share this podcast episode to increase awareness of the resources available for all Floridians.

April Salter: Well, hello. I am April Salter, the founder and CEO of SalterMitchell PR, and today I'm interviewing Melanie Brown-Woofter, the president and CEO of the Florida Behavioral Health Association. And Melanie, I am just delighted that you could be here with us today. You have such a long history of service to the state of Florida in many, many different ways, so you come to your position with a ton of experience and probably just a lot of good stories to tell.

Melanie Brown-Woofter: Absolutely, April. Thank you. It is wonderful to be here, and we certainly appreciate this opportunity to be able to share the good work that our members do.

April Salter: Absolutely. And Fluent in Floridian is really a podcast about the people that shine brightly in the state of Florida and who make a difference in people's lives, and the backstory that a lot of people may not know. So I know you were born and raised in Wakulla County, which is just to the south of Tallahassee. For some of our listeners who may not know, Wakulla County is a small county, but growing, and it's kind of become sort of a bedroom community to Tallahassee, but is so rich with natural and environmental treasures. So tell us a little bit about what it was like to grow up in Wakulla County and your background.

Melanie Brown-Woofter: Well, I think it was the best place to grow up. It was absolutely wonderful. I was actually born in St. Petersburg, so I'm a native Floridian, and then my father's family has been in Wakulla County since the mid-1800s. In fact, the piece of property that we built our house on and I grew up in had been in the family since around 1860. So lots of history, lots of generational work there, and in the middle of the Apalachicola National Forest. So as you say, very rural, very family oriented, but very community oriented. People looked out for each other. Everyone knew everyone, which when you are being a little mischievous, that's not a good thing, but otherwise it's really a positive way to grow up. Very helpful.

April Salter: So when you think back on growing up there, what did you like to do as a kid?

Melanie Brown-Woofter: We were in the middle of the forest, so things to do were outside, so we always had a garden, we had animals. We just used our imaginations and pulled our wagons down the road and did lots of fun things like that. And then of course as we got older in school age and then high school, there was always activities there, so we had to drive a lot, but there are always friends around. I do remember my grandparents always wanted us to be in church, church is very, very important to that community, so every Sunday we did that and my sister had an egg and butter route, so she would sell eggs.

April Salter: Oh my goodness. You had chickens?

Melanie Brown-Woofter: We had chickens, we had a cow. We milked the cow, we made our own butter. We did everything. In fact, a funny story that I tell people is I was really in junior high before I knew that you bought meat at the grocery store because we raised our own, so we smoked our own bacon and we had a cooler to age our beef in. Everything was very much from the land.

April Salter: Wow, you may be one of the last generations in Wakulla to still have that. Do you see that still? Is there still-

Melanie Brown-Woofter: There's still families that do it, yes. In fact, our family... I have cousins that still do the same sort of gardening and producing the meat.

April Salter: That's a wonderful way to grow up when you think about self-reliance and the lessons that you learn about responsibility and caring for cows and pigs and chickens. So that's very interesting. As you began to grow up, then you went into nursing school. You went to nursing school. Tell me a little bit about your decision to do that.

Melanie Brown-Woofter: Well, I had several ventures, and actually a couple of family members who had gone into nursing, and I went to the University of Florida... Actually when I went to UF, I had decided I was not moving back. I was going to live in the city, if you will, and establish a career. And I started off in the College of Business, and soon decided that really wasn't for me and applied to the nursing school and just felt like I was home. It was just exactly where I wanted to be. It met my needs and I just felt very comfortable there. I spent a lot of time at the library, a lot of time with clinical and with my patients. And it was interesting because when I got on the floor for clinical, I would make decisions and care for patients, and my student peers would say, "How did you know to do that?"And I said, "I just knew it. It just had come to me." And I was kind of surprised that they didn't know that this needed to happen.

April Salter: You mean from a mental health or behavioral support?

Melanie Brown-Woofter: From a mental health, behavioral health, as well as from a clinical position, just like recognizing the symptom, we need this intervention. And then being able to look at the whole person and say, "What are the needs when they go home? What are the needs here? What education needs to happen and what kind of support do we need?"

April Salter: Well, I bet you were a very effective nurse.

Melanie Brown-Woofter: Thank you. I do miss the clinical world. It was absolutely wonderful, but I do miss it. But then stepping into the role of policy, at that time, my goal was to change the world one patient in one family at a time, and then in a very short while you realize that if you're going to do that, you need billions of years because... You're probably not going to live long enough to be able to do that. When you move into the policy world, then you can see that changing policy actually helps to impact thousands and hundreds of thousands of lives at a time for the better if it's good policy and it's implemented well. So that really became an interest to me. So when I left the clinical world, and I had lived in Austin, Texas for a while and went to graduate school there, and then when I came back, I worked for the Agency for Healthcare Administration and the Medicaid, and so-

April Salter: And what years was that?

Melanie Brown-Woofter: I came back in 2000. So I was there for about 14, almost 15 years.

April Salter: Wow. A lot of change happened during that time period, I mean, just in terms of Medicaid and coverage levels and-

Melanie Brown-Woofter: And managed care, and we brought in behavioral health as a fully managed care covered service before it had been what we call carved out, which meant it just stayed in Medicaid fee for service, and then we were able to bring it in under managed care and then expand managed care statewide as well.

April Salter: So how did that change services for people, those changes? What difference does that make to people who have Medicaid services?

Melanie Brown-Woofter: Well, the goal was that it was seamless to the individuals in Medicaid who are receiving treatment, that they could go to see their physician, schedule that service, be seen, and then the payment and all of that administrative burden would be removed, and it would just be between the provider and the managed care plan. The other goal was to bring in managed care to expand access to services so that Medicaid recipients had a wider choice of providers, especially specialty providers, so that they could choose their care and craft the plan of care that they needed. And if they couldn't do that by themselves, that there would be care coordinators or case managers there through managed care to be able to help them make those decisions.

April Salter: Yeah, that's a big undertaking. It was the change, then, to making it more like private healthcare, where when you have private healthcare, you don't have to worry so much about all those interfaces and juggling all of that. So that was a pretty big change. Can you talk a little bit about maybe some pivotal moments or things that influenced your change or transition into advocacy and leadership? Was there kind of a aha moment or something that made you say, "I really want to make this change?"

Melanie Brown-Woofter: I think I've always been an advocate at heart. Even in clinical work, in the hospitals, on the floor, or in the community health center, I just felt called to stand up for the individuals, for my patients, and to make sure that they were able to receive the resources that they need. So I think it was just a logical step when I moved into policy to say that I could dictate policy for literally millions of people in the state and then work to make sure that that policy was implemented and upheld so that there weren't... The plans wouldn't take advantage of it, or that individuals could get what they need. Because in the Medicaid population, there is literacy issues. We tried to issue our information at the fifth grade reading level, and there's a dearth of resources. There's food insecurity people. If the doctor's appointment is all the way across town, they may have to make seven bus stops in order to be there, and they miss an entire day of work, and if you're an hourly employee, that day of work could make the difference between being able to have food on the table at the end of the week or not. So we really had to be aware of all of those sorts of things and really say, "What else can we bring to the table to make access easier? And then how can we recruit providers to come in and serve this population as well?"

April Salter: Yeah, that's such an important work. And now you are in a key leadership role that influences many clients and many people in need through your work on behavioral health. As you think about those changes in mental health and behavioral health, how has that changed over the years in terms of how people think about mental health and the role that it plays in the medical world and how that's linked together?

Melanie Brown-Woofter: That's a wonderful question, and we have been fortunate to see just an explosion in the awareness of the importance of mental health. I think over the years mental health has had a sort of secrecy around it, and it's almost an embarrassment. So if you have a mental health issue, people didn't want to talk about it. It was something that you kept quiet. And then there weren't very many resources available. It was either deep in services like the state mental hospital, or there were some independent practitioners that you could see, but not really prevention efforts and education and that sort of thing. So in the last several years we have really seen an interest in mental health. The pandemic helped to bring that on. And as people got really anxious, more depression, and I know from our... So our association serves primarily Medicaid, the uninsured, and the underinsured.

So we have seen more people coming into service, more people calling for a service, and this could be preventative. "I'm just feeling sad today. I really just want to talk to somebody." But we're also seeing increase in acuity, which means they've waited to come in until their symptoms are so acute that you really would need an inpatient series, a treatment on the inpatient setting. But one thing that people now are talking about it, we see sports professionals, we see actresses and actors, we see people in high levels of government that have come forward to say, "I've had depression. I am bipolar. I have anxiety. I'm living with schizophrenia." So that has really helped to make it more common that people can talk around the dinner table. You hear conversations in the grocery store. When people come back into the office, they talk about it too, like, "Oh, my sister has this, or my daughter's feeling this way." So just to be able to have those conversations has changed things enormously.

April Salter: I was fortunate to work for Governor Lawton Chiles, and he was one of the first politicians and public figures who came out and said, "Yes, I have been taking medication for depression." And it became kind of a political issue like, "Oh, what's going to happen if he's governor? He is, got depression." And he didn't shy away from talking about it, and I think that's such an important thing for these celebrities and other people to talk about it and to normalize it and say, "We are all humans with bodies and minds and souls that need attention."

Melanie Brown-Woofter: Oh, absolutely, absolutely. Abraham Lincoln suffered with depression, and look at what he was able to accomplish. So definitely being able to speak about it is wonderful. Postpartum depression is another thing. So before women would have babies and if they had a cohort of friends, they could talk to each other about it, but you didn't really talk about it out in the community. And now we realize that a significant portion of women do suffer with postpartum depression, and it's something that we need to address, and that there's-

April Salter: It can be managed.

Melanie Brown-Woofter: Absolutely. And now their OBs, when they go in, can make referrals and say... And look for the signs now. Before it was always like, "Oh, you're going to be fine. Don't worry about it." But now we actually have a questionnaire and a screening and they say, "yes, this may be going on. Let's get you some help." So wonderful.

Heidi Otway Interlude:  The Fluent in Floridian podcast is brought to you by SalterMitchell PR, a communications consultancy focused on helping good causes and clients win. We provide strategic insight and guidance to organizations seeking to make an impact in the nation's third most populous state. Learn more at smprflorida.com. Now back to April's interview with Melanie Brown-Woofter, the president and CEO of the Florida Behavioral Health Association.

April Salter: We've all gone through such a traumatic experience over the last few years with the pandemic and people dealing with the impacts of isolation and so forth. How has that impacted the work that you do? What are you seeing and are we coming out of that or are we seeing less of it, or how long do we think this COVID effect will have on our mental health?

Melanie Brown-Woofter: Well, right away we didn't see much of an impact. In fact, we saw a reduction in the number of individuals coming in, mainly because people were at home, like you say, they were isolating. And then as time went on the anxiety started to rise, the depression started to rise, and unfortunately physical violence in the home began to rise as well. So we as people who would come in crisis, they also had been involved with physical violence and had other issues in terms of lacerations and those sorts of things, as well as the mental aspect of it. So now since the pandemic, we have seen it a rise in individuals seeking services, but at the same time we've seen a decrease in the workforce. So workforce is something that we haven't been able to talk about yet.

But during the pandemic when people were at home and they could work remotely, they realized that, "Maybe I don't want to have to come into this job every day. Maybe I would like to live somewhere else, but I could work remotely." And there's also been an increase in the marketplace for behavioral health professionals. So more industries are hiring behavioral health professionals than ever before. So when they have a wide variety of choices, recruitment becomes an issue and retention as well. So we saw an increase in people seeking services, which is fabulous, and we were so excited. But then we saw a depletion of the workforce because they were moving on into other sectors. So quite a conundrum.

April Salter: Do you think that's from obviously the stress that goes with counseling people during such a difficult time?

Melanie Brown-Woofter: I think so, absolutely. Because you had stress at home and you had stress at work. So we really tried to implement some programs for self-care and to care for the [inaudible 00:17:44] health professionals, so that they had a way to have some respite and then to have that break from all those responsibilities at home, and then the responsibilities at work as well.

April Salter: As you look at your own life, obviously everyone has some sort of a support system. How do you manage the responsibility of running such an important association and cause, because it really is a cause, with your personal life. What are some of the things that you've learned to do and get support from?

Melanie Brown-Woofter: Well, I have an incredible staff. They are absolutely fabulous. So the work that we do really is not focused on just one individual. We all work together really, really well, and we share a lot of downtime and allow each other to decompress. So that's very helpful. And we're in contact with our membership, our providers all the way from Pensacola to Key West. But we have meetings once a week, and we started those, actually, a Zoom meeting during the pandemic, and it really began as a way for people to vent, if you will, and to say, "I'm having this problem." And then you have three other people saying, "I have the exact same problem," so you don't feel alone. And of course that created problems for us because we were like, "Okay, what's the solution? How can we find you these resources? What can we do?"

But it's morphed over time to an informational gathering, and it still is a time that we can all come together as leaders of particular agencies and really look at the landscape in Florida and see how we can help one another. It's been amazing to see people step up and say, "I have this. I can send you that." Or, "I tried this and it worked really well. You can try that as well." And I maintain a home in Wakulla now, and my parents still live in the same house that I grew up in so I can get away to the great outdoors and to-

April Salter: You like to hike or...

Melanie Brown-Woofter: Yes, I hike a lot and we get on the boat and get on the water. And we have the beaches, of course, that are there. So it's just nice to be able to be that. And my family is still here too. So lots of fun things. And I enjoy travel. So with our organization being across the state, it's really nice to go and visit our members too, and see what's happening in local communities and what's going on.

April Salter: Yeah, you must really have a good pulse on the communities because you're visiting these facilities and professionals who are seeing so many people, so that really gives you an inside look. How do you think Florida is faring?

Melanie Brown-Woofter: I think we're doing really well. We're part of a national association for mental well-being, for behavioral health. And when I listen to my peers in other states, Florida is ahead of the curve on many, many issues, especially around prevention. The increased attention that we've paid to opioid misuse and to substance use disorders, as well as funding for mental health. The last few legislative sessions we've really seen a commitment by the legislature to actually fund our system of care. So many people would say our system of care was broken. I would say it's neglected. We haven't properly funded it, we really haven't paid attention to the continuum of care and to good policy, and we've really seen some changes over the last couple of years. And I do have to say a lot of that has to do with First Lady Casey DeSantis and her awareness and her initiatives around mental health and substance use disorder and resiliency.

April Salter: Tell me a little bit about that.

Melanie Brown-Woofter: She has just been a champion. She has been one in Florida to really break the stigma, if you will, and normalize conversations around mental health and substance use disorder, and really recognizing that resiliency is key to people being able to live with disorders and to seek recovery. So for a long time we've looked at a medical model. Either you take a medication and this is going to make you better, or you pull yourself up by your bootstraps. So for years, substance use was a choice. We now know that it's a brain disease. And just like a mental illness, just like being bipolar. So now we recognize that we need to have those recovery efforts. Certainly we need the medical model there to help us, but we also need those supports in the community to be able to make sure that we all live to our potential and that we all can achieve well-being.

April Salter: So Florida, like many other states, has been plagued by the prevalence, the increase of fentanyl, meth, et cetera. What does that landscape look like in Florida? What are we seeing and what are the impacts that you've seen in the communities?

Melanie Brown-Woofter: Oh, it's still an epidemic. It's a war. We are going to have to fight this every day. So we've seen a rise in fentanyl. Luckily over the last year we've seen a decrease in accidental death by opioids. So that is absolutely wonderful. But it takes a multi-pronged approach to be able to address this. So we have the law enforcement, because really substance use, fentanyl use, opioid use is really supply and demand. So the demand comes from the mental health side. Either people are experimenting, maybe they feel anxious, so they're taking a substance to say... And I'm not being disparaging, but in our society it is just take a pill for it. Oh, if you feel this way, here's this. Even if it's just a vitamin. Oh, take this, you'll feel better. Take that, you'll feel better.

So people use a variety of substances and sometimes they don't know what's in them, especially if they are getting it from a friend or buying it on the street, that sort of thing. So we have that. And then we have those who have a substance use disorder. We know that their brains have been altered, the mechanism that's there, so they are susceptible to making those choices, or they feel that they have a craving and they can't stop. So we have to address it that way. So legally we look at it to reduce the supply. How can we put the bad guys away? How can we stop the supply of coming in? And then we look at it on the prevention, education, and treatment side to reduce the demand.

April Salter: And I know that there are some, I don't know what they call them, but things like Narcolex?

Melanie Brown-Woofter: Narcan. It reverses.

April Salter: It reverses the impact. How effective is that?

Melanie Brown-Woofter: Wonderfully effective. It has saved lives. It has saved just hundreds if not thousands of lives.

April Salter: And is that for opioid use or fentanyl or meth? What is the...

Melanie Brown-Woofter: It's mainly for opioid use, and it can be effective in fentanyl, but it typically is a larger dose, and we're looking at some different medications to be able to reverse the effects of fentanyl.

April Salter: And how do people get access to...

Melanie Brown-Woofter: I give it away free. So the community mental health centers in every community has it for free. The county health departments have it to give it away. Department of Children and Families, all of their regional offices have it. So we are trying to... Hospital emergency rooms are now able to give it away for folks who come in-

April Salter: So if a family member has someone suffering from substance abuse like this, I mean, what do they say? They walk into the receptionist office and desk and say, "I need some Narcan."

Melanie Brown-Woofter: Yes, absolutely. It's at health fairs, we are on school campuses, we are just everywhere and just giving it out. So there's no stigma associated with it. It's not giving someone a substance [inaudible 00:25:35]-

April Salter: They're not going to get interviewed, they're not going to get questioned about it.

Melanie Brown-Woofter: Nobody gets questioned about it. Nope. We just put it in your hands. I keep some in my bag.

April Salter: Is that right?

Melanie Brown-Woofter: Yes. I just have it because you never know. And just actually last week, one of our providers was sharing a story that a seven year old was able to use Narcan on his mom who was using. So just that young, he knew to open up the box and to administer the drug. So they're never too young to learn this. So it's not a bad thing.

April Salter: What a sad thing that a seven year old would need to know that.

Melanie Brown-Woofter: Absolutely. But better to do that than to lose your mom.

April Salter: Absolutely. Absolutely.

Melanie Brown-Woofter: Or your dad.

April Salter: Right, or anyone, any loved one. It's so great to hear the important work that you're doing. Is there anything that you'd like to add or anything that you think people ought to know about the work that you're doing or that the association is doing?

Melanie Brown-Woofter: We are so proud of the association. Our members have just been steadfast in their communities for years, and this is really a calling. This is not something that you do in order to advance your career, that sort of thing. I mean, you are really called to do this work. So we are just so thankful for everyone that work with us, that support us, and that we give individuals all across the state an opportunity to better themselves and to be well, and to stay in their community. And to the individuals who may be listening, you're not alone. You are not alone. There are so many people who feel like you and the resources are available. You're just a phone call or an email or a text away.

April Salter: That's wonderful. Well, what an absolute pleasure to have you on our show today. We appreciate that, and I loved hearing your Florida story. Thank you for all you're doing.

Melanie Brown-Woofter: Thank you.

Heidi Otway Outro:  Thanks for listening to this episode of the Fluent in Floridian podcast, brought to you by SalterMitchell PR. Our firm is focused on helping good causes and our clients win by providing strategic communications, issues management, crisis communications, media relations, marketing, and creative services. Our clients include Fortune 500 companies, small businesses, state and local government agencies, and nonprofits in Florida and across the US. As we celebrate our 25th year in business, we want to thank our clients, employees, and friends who've helped us reach this milestone. If you need help telling your Florida story, SalterMitchell PR has you covered. Reach out to us at smprflorida.com.