Mental Health Champions: Why & How Dr. Jim Dunford Of The McAlister Institute Is Helping To Champion Mental Wellness
I recommend people practice their communication skills more. Say hello to a homeless person rather than turning a blind eye. Promote being non-judgmental. Practice empathy — a trait more valuable than ever. I also hope seniors are invited to engage in the current debates — their wisdom shouldn’t be wasted when there is so much on the line for Homo Sapiens. Last, promote collective impact to address the issues that matter most to us all.
As a part of our series about Mental Health Champions helping to promote mental wellness, I had the pleasure to interview Dr Jim Dunford.
Dr. Dunford is the Medical Director at McAlister Institute, a remarkably caring organization of 400 employees dedicated to helping individuals with substance use disorders (SUD).
Thank you so much for doing this with us! Before we dig in, our readers would like to get to know you a bit. Can you tell us a bit about how you grew up?
I was born in San Francisco, but my dad’s job required our family to regularly pull up roots and relocate. By the time I graduated from Garden City HS (Long Island, NY) we had been to Buffalo, St. Louis, Detroit, San Rafael, and Chicago. As a kid it was difficult to say goodbye so often, but as I look back, I know the experience made me resilient and empathetic toward others who didn’t get a free pass to a stressless childhood.
You are currently leading a social impact organization that is helping to promote mental wellness. Can you tell us a bit about what you or your organization are trying to address?
I am very fortunate to serve as the Medical Director of McAlister Institute, a remarkably caring organization of 400 employees dedicated to helping individuals with substance use disorders (SUD). Our founder Jeanne McAlister is a treasured source of inspiration and guidance to the entire San Diego region. Her lived experience with alcoholism and celebrating 65 years of sobriety has transformed the approach to individuals suffering from the disease of addiction, as well as the stigma so often applied to them. Jeanne understood that SUD and mental health disorders routinely orbit like twin stars, and that a holistic approach that addressed both was critical to solve otherwise refractory challenges.
Can you tell us the backstory about what inspired you to originally feel passionate about this cause?
Through many years of first-hand experience caring for patients in the emergency department at UC San Diego Medical Center (and monthly stints in medical clinic in the county jail), I came to understand just how broken our mental health and substance treatment systems were. I saw countless patients wracked by serious mental illness, addiction, homelessness, and a host of other social conditions that made it literally impossible for them to escape a revolving door between jail, ambulances, emergency department and mental health facilities.
I became the first City of San Diego EMS Medical Director in 1997, to try to do something about it. I supervised the care provided by 400 paramedics and 600 firefighters for the eighth largest city in the country. Aided by cutting edge wireless health information technology deployed to EMT’s and firefighters, I (unlike any other physician in the country at the time) could identify the most complex, vulnerable individuals in the community in real-time.
I collaborated with an organization that was becoming the de facto social work department for the City, i.e., the San Diego Police Department’s Homeless Outreach Team. With the Court, City Attorney, the Public Defender, and others we created the Serial Inebriate Program (SIP) to offer alcohol treatment tailored to address the needs of the chronically homeless in lieu of custody. Until SIP, our clients were suffering on the streets, consuming vast public safety resources, and dying young. SIP was recognized by the Interagency Council on Homelessness and spurred other high-tech, high-touch initiatives to help vulnerable individuals with similarly refractory conditions. When I retired from the ED and the City, I felt I knew too much about the broken system to just sit at home or play golf. I continued to teach as Professor Emeritus until fortune came my way when an opportunity to work for Jeanne McAlister came along that I felt might provide one more chance to improve a part of the healthcare system that was sorely in need of help.
Many of us have ideas, dreams, and passions, but never manifest them. They don’t get up and just do it. But you did. Was there an “Aha Moment” that made you decide that you were actually going to step up and do it? What was that final trigger?
I’ve always wanted to do good deeds — I’m a do-gooder. After graduating from medical school, I wanted to give back for being lucky enough to become a physician. I likely got this drive from my parents, but I was also inspired by childhood icons, like John F. Kennedy and Martin Luther King, who were challenging the status quo. When I was 12, my hero was then-Secretary General of the United Nations Dag Hammarskjold. When I was 30, my five UCSD ED faculty colleagues and I became the first civilian physician in the country to staff a medical helicopter. I was dispatched all over San Diego County on Life Flight San Diego, an amazing experience that provided me my first exposure to the variance in healthcare across our region — rural, coastal, border, and mountains. I enjoyed the opportunity to represent the university by bringing cutting-edge care to everyone.
I continued that goal of building systems of care in later years to help address other systemic issues that contribute to the ruination of people’s lives. In collaboration with people with like minds, I again saw that otherwise intractable situations could be addressed through well-constructed teams. We built systems for sudden cardiac arrest, heart attack and stroke, a clean syringe exchange and more recently a Community Information Exchange that shares data among more than one hundred community business organizations dedicated to serving the vulnerable. Our first use case was trying to improve the lot of individuals with substance use disorder, mental health needs and chronic conditions who repeatedly access emergency departments when better outcomes would be achieved if their basic social needs could be delivered in a more coordinated way.
Can you share the most interesting story that happened to you since you began leading your company or organization?
Probably the most interesting thing that’s happened since I arrived at McAlister three years ago was having a ringside seat as fentanyl became the drug of choice for individuals with opioid use disorder in our community. Until just a few years ago, heroin ruled and overdoses were typically reversed with a single dose of naloxone by paramedics. Overdose victims routinely signed out against medical advice and thus infrequently encountered a physician during their “teachable moment”. The arrival of fentanyl changed the landscape; ODs now require multiple doses of naloxone, transports have risen, and death rates have soared. Remarkably, despite the risk, addicts sought out fentanyl for its potency. If there could be a bright side to any of this, I point to California’s “Bridge Program.” For the first time, ED patients presenting with serious opioid withdrawal found compassion at designated bridge hospitals prepared to initiate life-saving buprenorphine, which rapidly eliminated withdrawal suffering and provides a path to future compassionate care. It’s been extremely rewarding to be a part of this new continuum of care for people who were forever disparaged. We now have an audience willing to listen to the fact that addiction is a chronic disease (not unlike others that relapse and remit) rather than a character flaw.
None of us can be successful without some help along the way. Did you have mentors or cheerleaders who helped you to succeed? Can you tell us a story about their influence?
I’ve had fantastic role models during my career, my father among them. My dad had a small ceramic plaque in his bathroom that read “It’s nice to be important. It’s more important to be nice”. That says it all about how he approached the people in his life — he was a good guy around everyone. Early in my academic career, I was told by my boss that I was “too nice.” It was the first time I’d ever had to consider whether there was such a thing. I dismissed the comment and instead took it as a compliment.
I have had many wonderful professional influences: Dr. Andrew Bassett was a famous Columbia Presbyterian orthopedic surgeon. He had operated for over 35 years without ever being sued, something almost unheard of in his field. On rounds, I saw quickly learned his secret: he always introduced himself to patients and insisted on getting to know something about their personal life before he ever asked why they were in his office. Dr. Al Grokoest was another Columbia faculty member who cared enormously about his patients. Al was the physician for the New York Symphony and took care of many famous NY artists including influence expressionist artiist, Mark Rothko. He would bring young medical students together with promising musicians (including the creators of the Orpheus Chamber Ensemble) to challenge us to be cognizant of the world outside our careers. Another remarkable man was Dr. Jack McConnell, the chief medical officer of Johnson and Johnson. Early in my career, I helped rescue his son when he suffered a medical emergency on holiday in a small Mexican town. Jack immediately took interest in me and sought out opportunities for me for the duration of his life. I learned he was a humble but remarkable man, with hundreds of patents but without ever being anything other than a gentleman who cared about people. The AMA has a humanism in medicine award in his name. The list goes on– to this day I have coffee shop buddies in their 80’s providing me wonderful guidance and support.
According to Mental Health America’s report, over 44 million Americans have a mental health condition. Yet there’s still a stigma about mental illness. Can you share a few reasons you think this is so?
Stigma is born from a lack of knowledge. Where lack of knowledge becomes harmful and creates stigma is when uninformed people fail to pursue the truth. In the case of mental health disorders there are a myriad of stereotypes regarding what mental illness is, often propelled by media that portray people with mental illness as dangerous. The truth is there are only a small number of people with mental illness who pose a danger to others. Far more people suffer from fear of revealing their conditions and seeking assistance because of such erroneous thinking. You could argue that, in this world everyone should expect to suffer a mental health condition at some point in their life considering the near out-of-body experiences we encounter on the news every day: mass famine, wars, shootings, overdoses, suicides, fake news, dictators, devastating shifts in the planet’s weather on a daily basis. We were hunter-gatherers not very long ago. It should be no surprise that many people with mental health disorders attempt to self-medicate with drugs to find reprieve. Recalling that 90% of the actual health of individuals is linked to their “social determinants of health” (access to food, clothing, shelter, transportation, utilities, freedom from legal matters, etc.) no one should be surprised that an underfunded mental health system set the stage for our current epidemics of drug use, mental health crises and homelessness.
In your experience, what should a) individuals b) society, and c) the government do to better support people suffering from mental illness?
The governments at the federal, state, and local level needs to invest in readily available access to mental health resources and housing. When the locked mental health wards were (correctly) shuttered years ago, the expansion of community-based support did not follow. We need to invest in care where people are, not where someone else wants them to go for care. We also need to address the consequences of government inaction related to the negative consequence of gentrification of our neighborhoods over the past 30 years. In 1980, my ED patients with serious conditions such as delirium tremens often still had a home, usually an SRO in a downtown hotel. Those facilities were torn down to pave the way for development without considering the effects on the vulnerable people who lived there. We should spend as much on housing as we do on wars to right this social failing.
What are your 5 strategies you use to promote your own wellbeing and mental wellness? Can you please give a story or example for each?
My well-being comes first from knowing that my family has my back through anything. I have the greatest wife in the world. Renee is a smart, funny, hard-working gorgeous nurse who calls things like they are. Without her I’d be in bad shape.
Next, my three sons are spectacular people who have already lived through more challenges than many twice their age. My oldest son Michael was nearly killed as a young man when someone threw a rock threw his windshield, hitting him in the face. Despite the stress that followed he pulled himself together and ended up graduating from UC Berkeley. Today he’s a patient liaison assisting some of the most challenging people in the community to achieve better medical and mental health. My son Matthew is equally inspiring: an exceptionally high-functioning person on the autism spectrum, whose early life was challenged by teachers who didn’t understand him or even try. Today he is living his dream as one of the world’s most knowledgeable people about the Marvel Universe. His special skills routinely harness and apply the anthropological backbone of graphic comics in an industry that is worth billions. My son Christopher is equally brilliant and inspiring, leading our family to champion and celebrate the remarkable talents and value of the LGBTQ community. I draw from each of them every day.
When I need to really escape, I turn to exercise. I am a lifetime athlete: a runner for 35 years on the boardwalks of Mission and Pacific Beach and now a swimmer. I also love gardening. Renee and I grow milkweed just so we can watch Monarch butterflies lay eggs, hatch into caterpillars, form chrysalises, and fly away. My favorite plant now is my artichoke.
What are your favorite books, podcasts, or resources that inspire you to be a mental health champion?
I always have difficulty sitting still long enough to read books or even listen to them. On the other hand, I can read medical journals or science and nature magazines all day long. I tell my wife that I’m strictly nonfiction. I’m fascinated by nature, and my goal is to learn everything about the universe before I die. I was a Chemistry major as an undergraduate because I wanted to understand the building blocks. I see medicine as helping to understand how the parts have been assembled thanks to the remarkable genius of the laws of thermodynamics that drive evolution. Being a physician helps me try to blend nature and nurture together — that’s the art of medicine.
If you could tell other people one thing about why they should consider making a positive impact on our environment or society, like you, what would you tell them?
I recommend people practice their communication skills more. Say hello to a homeless person rather than turning a blind eye. Promote being non-judgmental. Practice empathy — a trait more valuable than ever. I also hope seniors are invited to engage in the current debates — their wisdom shouldn’t be wasted when there is so much on the line for Homo Sapiens. Last, promote collective impact to address the issues that matter most to us all.
How can our readers follow you online?
You can keep up with McAlister Institute at @McAlisterInc on Twitter, McAllister Institute on Facebook, and also their website at https://www.mcalisterinc.org/
Mental Health Champions: Why & How Dr Jim Dunford Of The McAlister Institute Is Helping To Champion was originally published in Authority Magazine on Medium, where people are continuing the conversation by highlighting and responding to this story.