‘A model of the possible’: inside a psychiatric unit for inpatient young adults | Documentary film

IThere is no typical day in the inpatient psychiatric unit at Northwell Zucker Hillside Hospital in Queens, New York. Patients arrive at Behavioral Health College Partnership’s 22-bed unit on a rolling basis, every day, immediately after or even in the midst of a mental health crisis; Patients also leave on a staggered schedule, ideally stabilized and with a continuing outpatient treatment program in hand. There are various diagnoses, medical interventions, therapy techniques and group sessions. There are no cell phones, plenty of board games, and a supervised yard. There might be, as some staffers put it in One South: Portrait of a Psych Unit, a rare documentary set in an inpatient psychiatric facility and the only one to focus specifically on college students, “enthusiasm” in the unity: agitation, escalation. , confrontation or moderation. For the most part, there are many young adults working hard to improve themselves.

The two-part HBO documentary series, filmed over eight weeks in 2022, captures a piece of the experience of patients and the unit’s psychiatrists, psychologists, nurses, social workers and mental health workers in one of the few programs country inpatient mental health designed for college. students. (Most importantly, the unit, which partners with 96 New York State colleges and universities and their student counseling centers, has insurance.) Although diagnoses and histories vary, the crises faced by patients at One South are specific and acute. A 26-year-old man arrives after an overdose, following months of increasing suicidal thoughts. A woman in her twenties, diagnosed with borderline personality disorder, struggles with feelings of abandonment and despair, and places a gun next to her bed. 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. An immigrant student, isolated from her family in China, hears voices telling her she is 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, about whether they could ever feel different, and with complicated feelings about their own hospitalization. “Inpatient care is the most stigmatized and least understood aspect of mental health care,” Megrue said, even as younger generations face a growing mental health crisis; The film begins with the statistic that one in 10 young adults in the United States are diagnosed with a serious mental illness. “If it’s diabetes, no one bats an eyelid. No one feels shame,” Shiva said. “There’s still the stigma of ‘oh, you need this type of care’”.

At One South, a handful of these young adults find a temporary community with peers who immediately struggle with major depression, suicidal ideation, anxiety, psychotic episodes, or personality disorders. The film follows the trajectory of treatment, from admission to group and individual therapy sessions, mindfulness activities involving dialectical behavioral therapy (DBT) and cognitive behavioral therapy (CBT), and the construction of a treatment plan. “We wanted to show an inpatient experience that we thought was a model of what’s possible,” Shiva said.

The ability to film such an experience required a robust, multi-layered consent protocol, starting with Northwell staff. Before any patient met with the film’s makers, a multidisciplinary team of psychiatrists, psychologists and social workers determined whether each individual was capable of giving consent. Some active diagnoses, such as florid psychosis or mania, exclude this possibility; patients who could 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 of the unit were not recorded – “what for some people may be good footage, was simply not appropriate, in our opinion.”

Braider sat down one-on-one with each patient and talked about the process, what their motivations were, and how they might feel about it in the future. Many felt that participating could help others in similar situations. “There was a feeling of ‘I’m getting help and I didn’t know I could get it, and I want other people to know this exists,’” Braider said. “It was more likely that we would stop filming than that they would be afraid or not want to. There was a feeling of ‘this is who I am’. And if this were cardiology, we wouldn’t be so worried about it.’”

The filmmakers also had many conversations with consenting patients before filming. The guiding question was: what are you comfortable with? Each participant set limits for filming: some participants were digitally disguised with the help of VFX and voice actors, some were filmed simply from behind, others only in groups rather than individual therapy sessions. “It was important that there be 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 felt comfortable talking about mental health, we wouldn’t need this movie.”

Photography: HBO

Still, “we were inspired by this age group and their comfort level in being open about it,” Shiva said. Along the way, each participant could request that the camera be turned off at any time or change their participation. The equipment was kept to a minimum: a cameraman and a soundman, while Megrue and Shiva watched on a monitor in a different room. The goal, Megrue said, was disappearance, following the model 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 about the filming, discuss their motivations for participating, and offer feedback on framing their stories. “That really helped us in the editing room, being able 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 clear, easy, or revealing; The work of managing serious mental illness is continuous, non-linear, and sometimes overwhelming, day to day. Patients leave One South with a long road ahead of them; some in the film express their determination to never return, or see departure as a simple step up from the bottom. 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 skills to manage overwhelming emotions. “It is the possibility of true freedom: freedom from shame, understanding themselves better, feeling in community,” Shiva said. “It was hopeful.”

One South is ultimately a portrait of a small, shocking corner of the vast, underfunded, overworked and often inaccessible American mental health system, trying to treat an increasing number of patients facing very difficult diagnoses. . But the filmmakers hope it will be powerful to show one aspect of mental health care, from provider to patient, particularly for a population that still has most of its life ahead of it. “When you tell someone that there is hope and that you can get help, they really don’t know what that’s like,” Braider said. “This shows what help could be like.”

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