July 24, 2024

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‘A model for what’s possible’: inside an inpatient psych unit for young adults | Documentary

5 min read

There is no one normal day at the inpatient psychiatric unit at Northwell Zucker Hillside hospital in Queens, New York. Patients arrive to the Behavioral Health College Partnership’s 22-bed unit on a rolling basis, every day, in the immediate aftermath or still in the grips 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 various diagnoses, medical interventions, therapy techniques and group sessions. There are no cellphones, plenty of board games, and a supervised patio. There could be, as some staff put it in One South: Portrait of a Psych Unit, a rare documentary to embed in an inpatient psychiatric facility and the only one to focus specifically on college students, “excitement” on the unit – agitation, escalation, confrontation or restraint. Mostly, there are a lot of young adults working hard to get better.

The two-part HBO docuseries, 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 at one of the nation’s few inpatient 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.) Though the diagnoses and backgrounds vary, the crises faced by patients at One South are specific and acute. A 26-year-old man arrives in the aftermath of an overdose, following months of escalating suicidal thoughts. A twentysomething woman, diagnosed with borderline personality disorder, struggles with feelings of abandonment and despair, and put a gun by her bedside. A 19-year-old first-generation college student feels there is 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’s a failure after her GPA drops.

All of the patients featured in the film, directed by Lindsey Megrue and Alexandra Shiva, arrive skeptical, at best, at whether they could ever feel differently, and with complicated feelings on their own hospitalization. “Inpatient care is the most stigmatized and least understood aspect of mental health care,” said Megrue, 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 are diagnosed with a serious mental illness. “If it’s about diabetes, nobody is batting an eye. Nobody is feeling shame,” said Shiva. “There’s still the stigma of, ‘oh, you need this kind of care.’”

In One South, a handful of these young adults find a temporary community with peers immediately struggling with major depression, suicidal ideation, anxiety, psychotic episodes or personality disorders. The film follows the trajectory of treatment, from intake to group and one-on-one therapy sessions, mindfulness activities involving dialectical behavior therapy (DBT) and cognitive behavioral therapy (CBT), and building a treatment plan. “We wanted to showcase an inpatient experience that we thought was a model for what’s possible,” said Shiva.

The ability to film such an experience involved a multi-layered and robust protocol of consent, starting with the staff at Northwell. Before any patient met with the film-makers, a multidisciplinary team of psychiatrists, psychologists and social workers determined whether each individual was capable of consenting. Some active diagnoses, such as florid psychosis or mania, precluded that possibility; the patients who could were largely diagnosed with major depressive disorder or borderline personality disorder. “We were very conservative” on 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 most intense moments on the unit were not recorded – “what may, to some people, be good filming just was not appropriate, 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’m getting help and I didn’t know I could get help, and I want other people to know this is out there,’” said Braider. “We were more likely to stop filming than they would be afraid of it or not want it. There was this sense of ‘this is who I am. And if this was cardiology, we wouldn’t be so concerned about it.’”

The film-makers, too, engaged in many conversations with consenting patients before 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 filmed just from behind, others just in group as opposed to one-on-one therapy sessions. “It was important for there to be a variety of ways for people to participate, so that everyone felt like they were collaborating with us and could come up with what was comfortable for them,” said Megrue. “If everyone was comfortable talking about mental health, we wouldn’t need this film.”

Photograph: HBO

Still, “we were inspired by this age group and their level of comfort with being open about it,” said Shiva. Along the way, every participant could request the camera be turned off at any time, or change their participation. The crew was kept to a minimum – a camera person and sound person, while Megrue and Shiva watched on a monitor in a different room. The goal, said Megrue, was disappearance, as modeled on old cinéma vérité documentaries – “how can we just be here and have as little impact as possible?” Each subject also participated in an exit interview, to debrief the filming, discuss their motivations for participating and offer input on how to frame their stories. “That really helped us in the edit room, to be able to figure out how to tell their story in a way that would feel really accurate and true to them,” said Megrue.

Those stories are not necessarily neat, easy or revelatory; the work of handling serious mental health illness is ongoing, nonlinear, sometimes daunting, day by day. Patients leave One South with plenty of road ahead of them; some in the film express determination to never be back again, or see leaving as simply step one from the bottom. Others are return patients. But there is a sense of hope, in sharing one’s experience and finding community in dark places, or working on skills for handling overwhelming emotions. “It’s the possibility of real freedom — freedom from shame, understanding themselves more, feeling community,” said Shiva. “It was hopeful.”

One South is ultimately a portrait of one small, impactful corner of the vast, underfunded, overworked and often inaccessible US mental healthcare system, trying to treat an ever-growing number of patients facing very difficult diagnoses. But the film-makers hope there is power in showing one aspect of mental health care, from provider to patient, particularly for a population with most of their life still ahead of them. “When you tell someone there’s hope, you could get help, they don’t really know what that looks like,” said Braider. “This shows you what help could look like.”


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