‘A model for what is possible’: in an inpatient psychiatric unit for young adults

TThere’s no ordinary day on the psychiatric ward of Northwell Zucker Hillside Hospital in Queens, New York. Patients arrive daily at the 22-bed unit of the Behavioral Health College Partnership, either in the immediate aftermath of a mental health crisis or still in the throes of one; patients also leave on a staggered timeline, ideally stabilized and with an ongoing outpatient treatment program in hand. There are multiple diagnoses, medical interventions, therapy techniques, and group sessions. There are no cell phones, plenty of board games, and a supervised patio. There might be, as some of the staff put it in One South: Portrait of a Psych Unit, a rare documentary that could be set in an inpatient psychiatric facility and the only one focused specifically on college students, “excitement” on the unit—agitated, escalated, confrontational, or withdrawn. Mostly, there are young adults working hard to get better.

Filmed over eight weeks in 2022, the two-part HBO docuseries captures a slice of the experience for patients and the department’s psychiatrists, psychologists, nurses, social workers and mental health professionals at one of the nation’s few clinical mental health programs that are designed for students. (Crucially, the department, which works with 96 colleges and universities in New York State and their student resource centers, accepts insurance.) While diagnoses and backgrounds vary, the crises patients face at One South are specific and acute. A 26-year-old man arrives after an overdose, after months of escalating suicidal ideation. A woman in her 20s, diagnosed with borderline personality disorder, struggles with feelings of abandonment and despair and keeps a gun next to her bed. A 19-year-old first-generation college student feels like there is no reason to live; he arrives after spending two hours on the George Washington Bridge and considers jumping off. An immigrant student, isolated from her family in China, hears voices telling her she is a failure after her GPA (grade point average) drops.

All the patients in the film, directed by Lindsey Megrue and Alexandra Shiva, are skeptical at best about whether they could ever feel differently, and with complicated feelings about their own hospitalization. “Inpatient care is the most stigmatized and least understood aspect of mental health care,” says Megrue, even as younger generations face an escalating mental health crisis; The film begins with the statistic that one in ten young adults in the US is diagnosed with a serious mental illness. “When it comes to diabetes, no one bats an eyelid. No one is ashamed,” said Shiva. “There’s still this stigma of, ‘Oh, you need that.’ this kind of care.’”

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

The ability to film such an experience required a layered and robust consent protocol, starting with Northwell staff. Before a patient met the filmmakers, a multidisciplinary team of psychiatrists, psychologists and social workers determined whether each individual was capable of consent. Some active diagnoses, such as floral psychosis or mania, ruled out that possibility; Those patients who were able to do so were largely diagnosed 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 on the unit were not recorded – “what might be a good film for some people was just not appropriate, given our criteria.”

Braider personally sat down with each patient and talked about the process, what their motivations were, how they would 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,’” Braider said. “We stopped filming sooner than they would be afraid of it or not want to do it. There was a sense of ‘this is who I am. And if this was cardiology, we wouldn’t be so concerned about it.'”

The filmmakers also had many conversations with consenting patients before filming. The guiding question was: what do you feel comfortable with? Each participant set boundaries for filming – some participants were digitally disguised using VFX and voice acting, some were filmed only from behind, others only in groups, as opposed to one-on-one therapy sessions. “It was important that there were different ways for people to participate so that everyone felt like they were working with us and could figure out what was comfortable for them,” Megrue said. “If everyone was comfortable talking about mental health, we wouldn’t need this movie.”

Still, “we were inspired by this age group and their level of comfort to be open about it,” Shiva said. At any time along the way, each participant could request to turn off the camera or change his or her participation. The crew was kept to a minimum: a cameraman and a soundman, while Megrue and Shiva watched on a monitor in another room. The goal, Megrue said, was disappearance, following the example of 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 recordings, 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 we could tell their story in a way that would feel very accurate and true to them,” Megrue said.

Those stories are not necessarily neat, easy, or revealing; the work of dealing with serious mental illness is ongoing, non-linear, and sometimes daunting, day to day. Patients leave One South with a long road ahead of them; Some in the film express a determination never to return, or see the departure as simply the first step from the bottom up. Others are returning patients. But there is a sense of hope in sharing experiences and finding community in dark places, or working on skills to cope with overwhelming emotions. “It is the possibility of true freedom – freedom from shame, understanding oneself better, feeling community,” Shiva said. “It was hopeful.”

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