Heidi Otway: Okay. So welcome to the Fluent in Floridian podcast. I'm so glad to have you both as guests on the show. You're going to not only talk about your Florida experiences, but you're also going to talk about the work you're doing in Palm Beach County to help people who are experiencing mental illness. But before we dive into that, let's talk about your Florida story. So Darcy, I'm going to start with you. Tell us what is your Florida story and how you got to where you are today?

Darcy Davis: So I came to Florida 14 years ago, my husband and I and our younger children from Georgia. Came down here actually for a job at the Health Care District so I've been at the Health Care District 14 years. I thought my kids would be Georgians, but I've raised them as Floridians, but it actually ties nicely. My mother's side of the family has been in Florida for five generations, Lakeland, Florida, right in the center of the state. Yeah, it's kind of nice. But I love it. It feels like home and I'm happy to be here.

Heidi Otway: Yeah, and being here for 14 years doing the work you're doing, you're officially a Floridian.

Darcy Davis: Well, thank you. I appreciate it.

Heidi Otway: Dr. Phillips, what is your Florida story?

Dr. Courtney Phillips: Yeah. Well, I'm actually originally from the Detroit area. I moved here in 2016 with one daughter, now have three kids and a wonderful family. A Florida family now. I think I moved because I was, at that time, finishing training. I was in my early 30s and looking for something different. And I've always said Florida has an element of that wild west feel that you hear about in the early 1900s where you come out and you kind of find your fortune and you find your adventure.

Heidi Otway: Yeah.

Dr. Courtney Phillips: I think it's true. Florida's full of opportunity. You don't know where it's going to come and I think it's full of opportunity even compared to other parts of the United States. And there's wonderful people. I now have a great network. But my Florida story I think is really tied to how I ended up with this organization and this mission. So I was kind of lost, finding my way, figuring out where do I fit here. It was serendipitous how I came together with this organization, this mission.

I have a huge passion for mental health, always have, lots of personal reasons for that, but also professional, and so did the Health Care District. And I think that they were ready and right to do something evidence-based and I was eager and ready to find my footing. And it's just turned into this beautiful relationship and a huge team, even outside of Darcy and I, that have really brought this to life and brought dignity back to mental healthcare, the same dignity that's afforded to physical healthcare, and I feel very privileged to have found that space and Florida. And again, the opportunity's been amazing. Florida's an exciting place to be and I'm happy to have a Florida family.

Heidi Otway: Yeah. A lot of us have experienced family or our own mental health issues and you kind of mentioned it a little bit. Do you mind sharing your story, please?

Dr. Courtney Phillips: Yeah, no problem. So I have a big beautiful family of my own. I have a little bit of a Brady Bunch family, two fathers. My biological father had a bad alcohol problem. He could not get his hands around it and he couldn't live in this world. He ended up dying of cirrhosis and he wasn't much of a father figure. But to me, he wasn't just an alcoholic. He was a dad. He had brothers. He had his parents who loved him and were very sad by what was happening. I loved him. I wanted him to turn around and he couldn't. And I think in the world that he lived, he was sort of on the outskirts of society with that. So personally, lots of therapy myself to deal with that. And I have a wonderful stepfather who stepped in, he's a great guy, and a really supportive family.

But when I see all these patients, when I used to see all these patients who were sort of thrown out of ERs and disregarded and maybe not given the same respect, I see a father. I see a friend, a sister, a mother, a daughter. I've worked in jails and seen lots of mental illness and I always think all these people have a mother who loved them, who held them, who said this was a really promising human being. And I think that that has driven me to want to bring excellence to this field and not just excellence, but accessibility. And I think Darcy shares that with me, that they deserve that compassion, but dignity and also excellence. That's kind of what we're striving for.

Heidi Otway: Yeah. So Darcy, let's talk about what the Health Care District of Palm Beach County is doing. Tell folks what it is because we know the name, but truly what makes you all unique, and then let's talk about the services that you all are providing for people who are experiencing mental illness.

Darcy Davis: Sure. Well, the Health Care District is unique. I will say there is nothing like it in the country, in fact. In Florida, it's actually one of two independent special taxing districts. So in a nutshell, it's a healthcare safety net, but everybody uses that term "safety net." It seems to be a buzzword. But in fact, we are a healthcare safety net whereby those services where people might fall through the gaps, the Health Care District steps in. So for example, we have a hospital in Belle Glade, so out in the rural Glades area. It's a hospital that would not be there if not for the Health Care District. We have nurses in every school in Palm Beach County. We have a skilled nursing center for people who can't find long-term care elsewhere. We have federally qualified health centers and by definition, those federally qualified health centers are serving those who typically can't get care elsewhere.

We have primary care, women's health, dental services, and mental health. That was really the front door for somebody to enter through mental health. But really stepping back into how did we get into this mental health space, and Dr. Phillips has really touched on it a couple times, back in 2016 at my very first board meeting as CEO, my very first meeting, a reporter from the Palm Beach Post stood up and yelled at the board and myself and said, "You guys are killing people." And I thought, "Oh my gosh. What have I done? What have we stepped into? What's happening here?" And what she was talking about was the opioid crisis. People were dying. The Health Care District years prior to my arrival ... The Health Care District has existed since 1988 when the voters voted it in. But back in the days, the head got separated from the body.

The Health Care District was focused on physical health, the neck and down. And in that moment, in that meeting, we suddenly realized, "Well, where's the head? Where's the mental health? Where's the substance use? Why aren't we involved in that?" and it became my mission at that moment to step in and figure out how can we help with this? And that's when that call to action is really what brought Dr. Phillips, an expert in her field, an addiction psychiatrist, to us. And with our chief medical officer, Dr. Belma Andric, they began creating a model and our real first step into this besides seeing someone through that primary care avenue and integrating mental health into the physical health, which we think is part of that unique approach. But we started with addiction stabilization unit and that was an idea actually born in the car.

Dr. Courtney Phillips: Yes, on a trip like this.

Darcy Davis: On a trip.

Heidi Otway: Really?

Darcy Davis: Courtney, myself, our chief medical officer, and our previous director of our clinics at the time, we were driving to Orlando to look at what are other people doing and we created a model.

Heidi Otway: Road trip.

Darcy Davis: It was a road trip. Things happen on a road trip. You're trapped in a car together for however many hours.

Dr. Courtney Phillips: Magic.

Darcy Davis: Yeah, and we created a model at that moment which has now been replicated across the state by the governor. So it's now known as the COR project, Coordinated Opioid Recovery. Courtney left us for a brief moment to go really help launch that with the governor's office, but she came back to us to continue this amazing work. So maybe a long answer to your question, but that's how we're addressing this and we continue to innovate in the space with other approaches here.

Heidi Otway: Why is this moment so critical to transforming how mental health care is delivered? What I've observed is that more people are open to having the conversations, which we never really had before. So tell me about how you all are transforming how mental health care is delivered.

Darcy Davis: So I will say I think this moment, since COVID, people have become much more open and I think it's become much more socially acceptable to talk about depression and the whole social isolation aspect. People recognize being alone and confined to small spaces in their homes was not healthy for the long term and that we needed each other in that social interaction. So I think now more than ever, people are receptive and recognizing it. I know Courtney can give a better clinical answer. By the way, I'm a CPA. I'm an accountant. So I come from a non-clinical space, but I do have a heart for this. But I will say maybe Courtney can add on more clinically as to why this moment is the moment.

Dr. Courtney Phillips: I think you touched on it. I think we lost a lot of amazing Americans during the opioid crisis. It touched almost every family and so it became real to people. This is not just something you can pull yourself up by the bootstraps. It's a real, medical, psychiatric, social problem. That's what makes it difficult to treat because it's not like an antibiotic. You give it and it is cured, right? It's a complex issue that crosses medical, psychiatric, social systems, meaning criminal justice, the schools.

Heidi Otway: Yes, you're right.

Dr. Courtney Phillips: And so I think that blew it open and then COVID also blew it open with our youth. Our youth really struggled during that time and continue to have some of the side effects from that. And I think it's finally recognized that mental health is going to dictate all the other health aspects as well. There's been some really good research. So I agree with Darcy. It's been an amazing journey. When I first started, I went into psychiatry. It wasn't a competitive field. It was kind of like, our CMO would say, sort of a stepchild of medicine. But that's changed a lot and I think people value it more, being mentally well, being healthy, as part of their overall care so I think that's part of the special moment right now.

Heidi Otway: Yeah. Even in my own family, we have been talking about our mental wellness. And when I talk to family members, one of the things I find is that they're struggling to actually find a mental health practitioner.

Darcy Davis: Absolutely. There's such a shortage for sure.

Heidi Otway: There's a shortage. So can we talk a little bit about that, the resources available?

Dr. Courtney Phillips: I like to talk about that because a psychiatrist for many years now, four or five times a week, especially if you're in a leadership position, people call and say, "Hey. Help me find someone for my kid, my family." People I work with, people I live near, and I don't mind at all. It's something that I think is an honor and privilege that people feel comfortable doing that. But I always ask myself, "Does a cardiologist get called every day when someone has chest pain? What do I do?" They don't. Someone has chest pain, they know what to do. We've been trained as a society. "I go here and I know if I go here, they're going to address it. And whatever my payment situation, this is going to be addressed and then I'm going to be able to get outpatient care." There's a system in place that people are familiar with. "If it's bad enough, I'll call 911," right?

And I think at the end of my career, and I think Darcy too, if people feel that they can have access like that for a mental health problem, whether it's really severe and significant or it's, "I'm just having a lot of panic attacks," "I'm having some adjustments at work," "I just moved to college. I don't know how to handle it," if people just know where to go, if we get that in our psyches literally of how to get help for that and it's not so hard and you can access something within a day or two as opposed to, "Oh, we're booked out three weeks," then I think that we've done our job in this generation and it'll be the next generation that has to move the chains. But that is something I think that the Health Care District is really trying to do in Palm Beach County, which is to say there is a place you can go or there's a way you can get help right now.

Heidi Otway: Yeah.

Darcy Davis: Well, it's something unique from a workforce perspective. So this is a bit different in the mental health space, but the use of peers, someone who has lived experience. You use the example of a cardiologist. They don't call a cardiologist, but they also don't go ask someone who had a heart attack how to take care of themselves. I do think because of what we're experiencing with the shortages in actual mental health professionals and techs, having a peer to help someone navigate mental health has been invaluable and we're using those in our space maybe.

Heidi Otway: Yeah, tell me more about that.

Darcy Davis: All kinds of peers. So go ahead.

Dr. Courtney Phillips: So yeah, the people with lived experience are huge and engaging folks into wanting to get this help because mental health care differs. There's a cultural overlay to it. There's a place where people feel comfortable. There's a whole bunch of people who feel more comfortable talking to a pastor or priest than to a therapist and we need to accept that. That's where they're at.

Heidi Otway: Yeah.

Dr. Courtney Phillips: So I think peers are amazing and exactly what you said, kind of bridging the gap between people who they need something, but they don't know if they feel comfortable with the institution. So I think the other thing we have to do is not just develop the workforce and expand, but peers are a good example of that. We have to be creative with the resources we have. I hope this leads to innovation. I do think that the old models are not as efficient as they could be in terms of taking a valuable resource and spreading amongst a lot of people, and there are models for that. But also, using people like peers who don't have to go to school for 10 years, they really just have lived experience to engage people. That can be enough, or a coach, and to have those different levels of access points that people can access.

I was shocked. In Palm Beach County, there's a pastor. His name is actually Pastor Whiteley. I don't know if he'll hear this, but he's very engaged in mental health. He's learned a lot about it. They have a counseling center just for their parishioners. I think that's so progressive ...

Heidi Otway: That is. Wow.

Dr. Courtney Phillips: To take that approach. Schools are doing a lot more. I think law enforcement, surprisingly, has really stepped up.

Heidi Otway: Yeah, let's talk about that. Yeah, I'd like to hear more real experiences.

Dr. Courtney Phillips: So I think that those are the ways that we have to expand. We can't look at the traditional workforce and say, "This is it." We have to expand that so that there is more access.

Heidi Otway: Yeah. I mean, even in the workplace within my own team and then within my own network, I find myself serving as an ear.

Darcy Davis: Absolutely.

Heidi Otway: Sometimes people just want to be heard.

Darcy Davis: Exactly.

Heidi Otway: Because then once they get it out and then you have someone say, "I hear you. I understand. It's going to be okay. Oh, and if it's beyond what I can share, let me give you some resources," that makes a difference as well.

Darcy Davis: Looking for validation and just saying, "It's okay to be where you are in that moment."

Heidi Otway: It's okay, yeah.

Darcy Davis: Exactly.

Heidi Otway: Yeah, so talk to me about the evidence-based clinical approach to solving a crisis rather than just relying on non-clinical support. So we talked about all these various layers, but let's talk about the evidence-based.

Dr. Courtney Phillips: So there is evidence-based and there is a model that's working, and it's a system of care similar to what we did with COR where there's sort of a right now response and a place for someone to go right now. So I would say the right now response, similar to 911, there's a movement towards 988.

Heidi Otway: Yes.

Dr. Courtney Phillips: It's actually a federal, national movement and it's making progress. And our CMO says this, Dr. Andric, but it took 10 years for 911 to be adopted as an accepted call. Now everybody uses it.

Heidi Otway: Yeah.

Dr. Courtney Phillips: 988 is on that journey. They're at the beginning stages, but hopefully in 10 years that will be a more utilized and more robust system for responding to mental health crisis. The evidence shows that if 988 is set up properly, which Georgia is actually one of the better models for this, that if 100 people call 988, somewhere around 80% of it is resolved on the phone with quick access to appointments with a skilled clinician who can speak to the person on the phone, like you were saying, and sort of deescalate the situation.

But for the people where it doesn't work, they send somebody out to the person, almost like EMS. These are called mobile response teams that can go in a crisis to a patient, just like EMS goes to you for a medical emergency. There's lots of mobile response units around Florida that are either staffed with peers or therapists or both, and sometimes with an officer if the call seems like there's a little bit of an element of safety involved. So we have a co-responder unit with Palm Beach Sheriff's Office where we send a therapist and peer out to 911 calls that are mental health related.

Heidi Otway: Really?

Darcy Davis: We're piloting that because I believe the evidence will show that yet another large percentage can be resolved in the field again before somebody escalates such that they need to be Baker Acted or put in jail. So it becomes that emergency room diversion, jail diversion in that moment.

Dr. Courtney Phillips: And then most of those are resolved. So at the end of 100 people, you get about four people that end up at the crisis center who still need that level of care. And usually within the crisis center, if it's run properly with the evidence-based models in place, only two of them need to end up in a bed. The other two can be resolved there and sent back home. And this is really important because it is a big deal to Baker Act someone and take their rights away. It's also very costly which is why there aren't enough beds. So we think that there's an over-utilization of beds because there isn't anything upstream like getting an appointment. As you said, it's, "Where do I start? How do I get in?" Especially kids are waiting so long to get this help. It's leading to crisis. So we need to have crisis centers, but we need to have all the steps in place before that to be truly evidence-based in this model of care.

Heidi Otway: Well, that is so remarkable what you just shared and it sounds really promising.

Dr. Courtney Phillips: Yeah.

Darcy Davis: It's exciting.

Heidi Otway: It is exciting. Yeah.

Darcy Davis: It's very rewarding to see the impact that we know we can make. And every day, as our mobile teams are out there on the streets and as we start to gain momentum into building this crisis center, we know that this is going to save lives.

Heidi Otway: Yeah.

Dr. Courtney Phillips: But the interesting part of the model that I didn't talk about that's very important is it only works, too, if doctors treat. Doctors, we love medicines, we love therapy, interventions, but we have to treat the person's connection to the world. So people, place, and purpose is talked about in the evidence. If someone doesn't have people who care about them, a place to belong, a place to live, a place to go, or a purpose in life, they're not going to long-term get well. So I think what's unique about what we're doing is we are not those providers. There are a lot of social care providers. But we're integrating the social care into this crisis center so that the person, yes, they get the maybe medical intervention, the psychiatric, the therapy intervention, they get peers, they get that.

But also, waiting in our living room area, the engagement center/discharge lounge, is the homeless teams, maybe the food bank people, everyone who can connect them. The churches, the people who say, "Come be with us." The peer places, the clubhouses. All of those things that also contribute to someone's wellness really long-term because if you're isolated, it's hard to get better.

Heidi Otway: Yeah, it almost sounds like it's a wraparound service to give people a sense of belonging and that people care.

Darcy Davis: Exactly.

Heidi Otway: Because at the end of the day, people want to be seen and heard, right?

Darcy Davis: Right.

Dr. Courtney Phillips: Yeah. And I think this is a softer thing, but we really try to train our staff in that when we have someone who relapses for the 10th time. They come in and say, "I disappeared for six months. I'm back." "We're so glad you're here. I'm so happy you're here." Even our front desk says that. "Don't worry about it. We're going to figure out how to work around this now. We're going to learn from it. But you came back today. Awesome." So they're met with that warmth as opposed to, "You screwed up," or, "You're in trouble." It's a welcome. "Don't be ashamed. You got here today. That's great."

Heidi Otway: I love that. I love that. Darcy, as a CEO, how do you balance the mission of improving mental healthcare like what you all just talked about, with the financial and operational realities of running a very unique Health Care District?

Darcy Davis: Well, I mentioned earlier I am a CPA. I come from a financial background. No, honestly, it is a balance because we know that there is the significant expense to this from a mental health investment. And so part of what we talked about with those mobile units is piloting something, proving those outcomes, proving the model before we go in and invest. I think we have been very good stewards of taxpayer dollars in the healthcare space. When I got to the Health Care District, I come from a healthcare finance space, but it was run very much like a government. We have brought in healthcare experts, people who are top of their field, like Courtney here, who understand and understand healthcare. And we changed the organization from being, I would say, a bureaucratic, governmental entity to being a lean healthcare organization. And we are constantly evaluating, "Does this still make sense?" So most governments tend to just keep growing. We grow and contract.

One of the things that the Health Care District did several years ago was when Medicaid managed care expanded when Governor Scott rolled that out, the Health Care District had an HMO. Well, we sold the HMO. We don't need to be in that space anymore. It no longer makes sense. So knowing when to expand and when to contract. And right now, we expanded mental health, but are there other places where we should be tightening our belts? We're constantly looking at every program again to make sure, "Does this still make sense? Is it right, right now?"

Heidi Otway: Yes. That's wonderful. What about your workforce? How is that?

Darcy Davis: We have approximately 1,400 employees across the county. You know what? We really struggled during COVID, as everybody did, to get the resources we needed. We had some creative models, clinical float pools to get people where we were having shortages. Now we're doing a lot better. We have a really strong recruitment team, HR team, and I will tell you we have one of the lowest job opening rates that we've had in district history. But I think people are attracted to the Health Care District because of our mission. They come because of what we do and who we are and they recognize that they have a rare opportunity to serve a population who really is grateful. I hear that all the time out at our hospital and our clinics. The patients are so grateful.

You would be surprised. Most healthcare environments, there's a very litigious patient population. They always want to raise the flag about something that didn't go right. We hear, more than ever, what went well. People tell our doctors thank you. Again, I'm not a clinician, but I get our workforce telling us all the time, "This is another grateful patient." Not to say there aren't a few unhappy ones because it happens.

Heidi Otway: Yeah. I mean, you have multiple facilities and services.

Darcy Davis: All over the place.

Heidi Otway: You're all over the county.

Darcy Davis: We are. But yeah, overall sense of gratitude from our patients for being there. It really is very rewarding, but I think it's what brings and attracts a lot of our employees.

Dr. Courtney Phillips: Yeah. And on the provider side, one of the things that attracts us, the leadership team that Darcy has fostered has actually ... They're never afraid to take on an expensive project. They make us think through the efficiency, if it's the right thing to do. She's very creative in her executive team on the finance side figuring out, "Okay. Well this is the right thing to do. We're going to do it." We can't do it without figuring out a solution and she tends to do that. So I think on the doctor side, we feel safe with that approach because we want to do the right thing for the patient, so does the leadership team. And I think that translates from the top and it goes across the organization.

Darcy Davis: Thanks.

Dr. Courtney Phillips: Yeah.

Heidi Otway: I love that. So we talked about mental health. We talked about the services you provide. I want to hear about the Tomahawks.

Darcy Davis: Trauma Hawks.

Heidi Otway: Trauma Hawks.

Darcy Davis: Oh, the Tomahawks [inaudible 00:26:54] the Trauma Hawks.

Heidi Otway: I want to hear about the Trauma Hawks.

Darcy Davis: Yeah.

Heidi Otway: I mean, I saw that and I was like, "That is so cool."

Darcy Davis: It's brilliant. It is. You know what? Those are our sexiest toys, I'll tell you.

Dr. Courtney Phillips: She wants a ride on the Trauma Hawk. She does.

Heidi Otway: I want to ride on a helicopter with a Trauma Hawk. Can I join you for that?

Darcy Davis: I was going to say they're pretty cool, I will say. They actually are a really valuable service. We have a great partnership with Palm Beach County Fire Rescue. The Health Care District owns and operates the helicopters. So we have the pilots, the mechanics, the hanger, but in the back are the fire rescue folks who are actually taking care of the patients. So yeah, we are there to respond to traumas. We do inter-facility transfers. It's really impressive. Very cool.

Heidi Otway: It is very cool. I watch all those fire rescue shows and everything and I'm like, "These guys and women could be their own reality show."

Darcy Davis: You know what? One of the things I would love to bring to Palm Beach County, talking about those services and figuring out where we could plug in, what we don't have in Palm Beach County that we need is fire suppression and search and rescue. So I do think now's the time for us to be looking to say because as Palm Beach County has grown to 1.7 million people and there's high rises everywhere, should there be another helicopter that has the capability to do that? So maybe it will take off.

Heidi Otway: There we go.

Darcy Davis: Maybe it'll take off. Maybe it won't. Maybe it won't, but I do think it's something we're exploring. Is now the right time to look at that also? So again, always looking to see what are we doing? Are we doing everything we can do?

Heidi Otway: Yeah. I like that you all are thinking one step ahead, one step ahead, and what the future of healthcare looks like in Florida.

Darcy Davis: Yep. Absolutely.

Heidi Otway: That's remarkable. So when you all are not in your CEO, VP roles, I want to know how do you unwind? What do you like to do? I mean, because I could tell you all are hardworking women. You're very passionate about what you do. But what do you do when you're not serving the district?

Darcy Davis: So I'm an empty-nester. My kids are 26 and 24 so I love to take as much time as I can with them, but of course they don't always give so much time anymore. But my husband and I, we love to go out on the boat. We have a place up in Georgia. We still go back, very rural. A different pace of life than South Florida so we really enjoy that. Sitting on the porch, watching the deer run through the yard. That'll really take it down a notch from a stress level, I can tell you.

Heidi Otway: Oh, of course. Yeah.

Darcy Davis: But yeah, that's my relaxation technique.

Heidi Otway: Thank you. Dr. Phillips?

Dr. Courtney Phillips: Well, I'm an avid puzzler. I'll tell you that. If I have a glass of wine and a puzzle, I'm very happy in my backyard.

Heidi Otway: I love that.

Dr. Courtney Phillips: I have one going right now. I know that's very nerdy. People talk about book clubs. I'm like, "I want a women's puzzle club." But I have three kids and a wonderful spouse and we just came back from a trip. My kids are 15, four, and two and we just came back.

Dr. Courtney Phillips: Yeah, I do.

Heidi Otway: I love that.

Dr. Courtney Phillips: Yeah, a little boy. And so we just came back from our family trip in the Caribbean in Grenada. My husband's from Trinidad so we like to go to the Caribbean and I'm from Michigan so we go up there. So we love to travel, but we love doing things in Florida too. Movies, staying home, puzzling, living in the backyard, and really enjoying these moments with my family. I'm very grateful to have them.

Heidi Otway: Yeah. Well, I want to thank you both for being on the Fluent in Floridian podcast.

Dr. Courtney Phillips: Thank you.

Darcy Davis: Thank you.

Heidi Otway: I've learned so much. I know our listeners and viewers have learned a lot as well. So thank you all so much for all that you do.

Darcy Davis: It's a pleasure. Thank you so much.

Dr. Courtney Phillips: Thank you for having us.

Heidi Otway: Yes, thank you.