“A model for what is possible”: inside a psychiatric unit for young adults | documentary

Tt here is no normal day in the inpatient psychiatric unit at Northwell Zucker Hillside Hospital in Queens, New York. Patients arrive at the 22-bed unit of the College of Behavioral Health Partnership continuously, every day, immediately after or still in check-ups of a mental health crisis; patients leave, too, on a staggered timeline, ideally stabilized and with an ongoing outpatient treatment program in hand. There are different diagnoses, medical interventions, therapy techniques and group sessions. No cell phones, plenty of board games and a supervised patio. There may be, as some staff put it in One South: Portrait of a Psych Unit, a rare documentary set on an inpatient psychiatric facility and the only one to focus specifically on college students, “excitement” in the unit. “” agitation, escalation, confrontation or restraint. Mostly, there are a lot of young adults working hard to improve.

The two-part HBO documentary, filmed over eight weeks in 2022, captures a slice of the experience for patients and the unit’s psychiatrists, psychologists, nurses, social workers and mental health workers in one of the country’s few inpatient settings. mental health programs designed for college students. (Crucially, the unit, which partners with 96 New York State colleges and universities and their student counseling centers, takes insurance.) Although diagnoses and backgrounds vary, the crises facing patients at One South are specific and acute. A 26-year-old man arrives after an overdose, after months of escalating suicidal thoughts. A twenty-year-old woman diagnosed with borderline personality disorder struggles with feelings of abandonment and despair and places a gun by her bedside. A 19-year-old first-generation college student feels he has no reason to live; he arrives after spending two hours on the George Washington Bridge, contemplating jumping off. An immigrant student, isolated from her family in China, hears voices telling her she has failed as her GPA drops.

All of the patients featured in the film, directed by Lindsey Megrue and Alexandra Shiva, arrive skeptical, at best, if they could ever feel any different, and with complicated feelings about hospitalization. “Hospital care is the most stigmatized and least understood aspect of mental health care,” Megrue said, even as younger generations face an escalating mental health crisis; the film opens with the statistic that one in 10 young adults in the US is diagnosed with a serious mental illness. “When it comes to diabetes, no one is raising an eye. No one is ashamed,” said Shiva. “There’s still the stigma of ‘oh, you have to.’ THIS kind of care.’â€

At One South, a handful of these young adults find a temporary community of peers who are immediately struggling with major depression, suicidal ideation, anxiety, psychotic episodes, or personality disorders. The film follows the trajectory of treatment, from taking in group and individual therapy sessions, awareness activities that include dialectical behavior therapy (DBT) and cognitive behavioral therapy (CBT), and building a treatment plan. “We wanted to showcase a hospital experience that we felt was a model for what was possible,” Shiva said.

The ability to film such an experience involved a multi-layered and robust consent protocol, starting with the staff at Northwell. Before any patient met the filmmakers, a multidisciplinary team of psychiatrists, psychologists and social workers determined whether each individual was capable of giving consent. Some active diagnoses, such as flared psychosis or mania, ruled out this possibility; patients who could be diagnosed primarily with major depressive disorder or borderline personality disorder. “We were very conservative” about what could be filmed, said Dr. Laura Braider, a clinical psychologist and associate vice president of behavioral health at Northwell Health. So much so that the most intense moments in the unit were not recorded – “what for some people might be good, the filming just wasn’t suitable, given our criteria.”

Braider personally sat down with each patient and talked about the process, what their motivations were, how they might feel about it in the future. Many felt that participating could help others in similar situations. “There was a sense of ‘I was getting help and I didn’t know I could get help, and I want other people to know it’s out there,'” Braider said. “We were more likely to stop filming than they were to They were afraid or didn’t want to. There was this feeling that “this is me.” And if this was cardiology, we wouldn’t worry about it so much

The filmmakers also engaged in many conversations with consenting patients prior to filming. The guiding question was: what are you comfortable with? Each participant set boundaries for filming – some participants were digitally disguised with the help of VFX and voice actors, some were filmed only from behind, others only in groups as opposed to one-on-one therapy sessions. “It was important to have a variety of ways for people to participate so that everyone felt like they were collaborating with us and could find what was comfortable for them,” Megrue said. “If everyone was cool talking about mental health, we wouldn’t need this movie.”

However, “we were inspired by this age group and their comfort level to be open to it,” Shiva said. Along the way, any participant can request that the camera be turned off at any time, or change their participation. The crew was kept to a minimum – one camera person and sound person, while Megrue and Shiva watched on a monitor in another room. The goal, Megrue said, was to disappear, along the lines of the old cinema vérité documentaries – – how can we be here and have as little impact as possible?†Each subject also participated in an exit interview, to reflect on the filming, discuss their motivations for participating and provide input on how to frame their stories. “That really helped us in the editing room to figure out how to tell their story in a way that felt really accurate and true to them,” Megrue said.

Those stories are not necessarily clean, easy or revealing; The work of treating serious mental health illnesses is ongoing, non-linear, sometimes daunting, day-to-day. Patients leave One South with many roads ahead of them; some in the film express a determination never to return, or see leaving as merely a step towards the end. Others are returning patients. But there is a sense of hope, in sharing one’s experience and finding community in dark places, or working on coping skills for overwhelming emotions. “It’s the possibility of real freedom — freedom from shame, understanding more of yourself, feeling community,” Shiva said. “It was hopeful.â€

One South is ultimately a portrait of a small, influential corner of the vast, underfunded, overburdened, and often inaccessible U.S. mental health care system struggling to handle an ever-increasing number patients facing very difficult diagnoses. But the filmmakers hope there’s power in showing one aspect of mental health care, from provider to patient, especially for a population with most of their lives still ahead of them. “When you tell someone there is hope, they can get help, they don’t really know what that looks like,” Braider said. “This shows you what help can look like.â€