Latest / 20-Minute Health Talk / Inside a psych unit: Behind the scenes of HBO's "One South" (Part 1)

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Inside a psych unit: Behind the scenes of HBO's "One South" (Part 1) · 20-Minute Health Talk

0:04
Lindsey Megrue: You know,
0:05
you have these ideas of what
0:06
inpatient care looks like,
0:08
and certainly this is only
0:09
one very specific unit,
0:11
but it was the opposite of what
0:13
you kind of classically
0:14
think of,
0:15
like those horror stories from
0:16
the sixties or one flew over
0:18
the cuckoo's nest,
0:19
like all of those kind of
0:20
media representations.
0:21
It was really the opposite
0:23
of that.
0:32
Sandra Lindsay: Hello,
0:32
and welcome to 20-Minute Health
0:35
Talk. I'm Sandra Lindsay.
0:37
Today we have the unique
0:39
opportunity to explore the
0:41
intersection of film,
0:43
mental health,
0:44
and the human stories that
0:46
bind them together.
0:47
And that's thanks to the
0:49
brilliant minds behind the new
0:51
HBO documentary series one
0:54
south, portrait of a psych unit.
0:58
I'm thrilled to be joined by
1:00
acclaimed filmmakers Alexandra
1:03
Shiva and Lindsey McGrew,
1:06
whose two part series offers an
1:09
unprecedented look inside the
1:11
world of a psychiatric unit.
1:14
This is an impatient unit at
1:16
Succor Hillside Hospital that
1:18
tailors treatment for college
1:20
age students with a range of
1:23
mental health conditions.
1:30
Alexandra is an award winning
1:33
filmmaker and co founder
1:35
of Gedalia Pictures.
1:37
She's known for her compelling
1:39
documentaries that highlight
1:41
social issues and human stories.
1:45
Lindsey is a producer with
1:47
Gedalia Pictures,
1:48
also a director.
1:50
She's known for her work on
1:52
films like we are witnesses and,
1:55
of course, one south.
1:57
Also joining us is Doctor
2:00
Laura Brader,
2:01
another brilliant mind and a key
2:03
clinician featured
2:04
in the series.
2:05
Doctor Breder is a clinical
2:08
psychologist and associate vice
2:10
president of behavioral health
2:12
at Northwell Health.
2:14
She also heads up its behavioral
2:16
health college partnership,
2:19
which we'll discuss today.
2:23
Alex and Lindsey,
2:25
I was so blown away by the
2:29
deeply intimate moments
2:31
captured in one south.
2:33
What was your inspiration
2:35
for the project?
2:36
Lindsey,
2:37
why don't we start with you?
2:39
Lindsey Megrue: Well,
2:39
Alexandra and I had worked on
2:41
another film about
2:41
mental health,
2:43
and one of the things that we
2:44
learned in doing that was that
2:46
there was still a lot of stigma
2:47
around inpatient care.
2:49
So when we finished that film,
2:51
we were doing some research and
2:52
to see if we could investigate
2:54
inpatient care further,
2:55
and we came across doctor
2:57
Breder's program,
2:59
and we were struck by how
3:01
unique the program was.
3:03
And we were also particularly
3:04
excited that the focus
3:06
is on young people,
3:07
which we thought would be
3:09
particularly hopeful.
3:10
Theres a lot of evidence that
3:12
says early intervention
3:13
leads to positive.
3:14
More positive outcomes.
3:16
And so we were excited to kind
3:17
of dig in and learn more about
3:21
inpatient care on the ground.
3:23
And we hit it off with
3:24
doctor Breder.
3:25
Sandra Lindsay: Now,
3:26
doctor Breder as a clinical
3:29
psychologist,
3:30
did you ever think you'd be
3:32
featured in an HBO documentary? Absolutely not.
3:37
Laura Braider: That's a hard no.
3:39
Sandra Lindsay: Tell us about the program.
3:41
You run out of One South,
3:43
the behavioral health
3:44
college partnership.
3:46
Laura Braider: Sure, sure.
3:48
So the behavioral health college
3:49
partnership really focuses
3:52
on emergency crises,
3:54
emergency assessment,
3:56
inpatient hospitalization,
3:58
and post hospitalization care
4:01
for college students.
4:02
And that's really an open area
4:04
that often falls through the
4:07
cracks where students do not
4:10
have that specialized care.
4:12
Sandra Lindsay: So how do students know
4:14
about your program?
4:16
Laura Braider: So anybody could come to the
4:20
lijed and be assessed and if
4:23
they need hospitalization,
4:24
enter the program.
4:26
Right now most of the students
4:29
come through their
4:31
partner schools,
4:32
so we partner with 96 schools.
4:34
There's no criteria other than
4:37
that they agreed to follow our
4:39
protocols for the safety of the
4:41
students and the community.
4:43
Sandra Lindsay: How long do patients typically
4:45
stay on one south?
4:47
Laura Braider: Typically,
4:48
our average length of stay
4:50
is seven to ten days.
4:52
Some people do stay longer,
4:54
depending on diagnoses or how
4:56
long it takes to stabilize the
4:58
unit is really for the purpose
5:02
of stabilization,
5:03
making sure someone is safe.
5:05
So we really work on safety
5:07
skills and hone in on those
5:09
skills that they can use when
5:11
they're immediately discharged
5:12
to be safe, safer,
5:14
and then there is a journey
5:15
afterwards.
5:16
Our job is to point out
5:19
what's happening,
5:20
help them understand what's
5:22
happening to them,
5:23
and to create a plan that gives
5:26
them hope and a journey forward.
5:28
Sandra Lindsay: Fantastic. Now Alexandra,
5:32
what were your expectations
5:34
going in,
5:36
and how did the reality
5:37
of it all compare?
5:40
Alexandra Shiva: I try not to have expectations,
5:43
and I think that's something
5:44
that we talked a lot about,
5:45
which is just getting into
5:49
going onto the unit.
5:50
And I think in terms of
5:52
making documentaries,
5:53
it's very important for us to
5:57
have the material and what is
5:59
happening lead the way.
6:01
So it's important to
6:03
not go in and say,
6:04
we're going to make a
6:05
movie about this.
6:05
It's going to look like this,
6:06
and now we have to figure
6:07
out people to fit into
6:09
a preconceived idea.
6:10
So I think we really didn't
6:13
know what to expect.
6:14
We spent a little time once we
6:16
started getting to
6:17
know the staff,
6:18
getting to know some
6:20
of the patients,
6:21
but I think it was really
6:23
led by the experience
6:26
and it was much more
6:27
challenging, actually,
6:28
than we expected it to be.
6:30
The most important piece that we
6:31
all discussed was making sure
6:34
that the patient's care
6:36
was never compromised.
6:37
That was very important,
6:38
obviously, to the staff,
6:40
but it's also very important in
6:42
our work that our footprint does
6:44
not impact what is happening to
6:47
the least possible ability.
6:50
So I think that was more
6:52
challenging than we expected and
6:54
also, to Lindsay's point,
6:55
much more hopefully.
6:57
I feel like I came away feeling
7:00
very hopeful about what it
7:02
means to be on the unit,
7:03
what it means for someone young
7:05
to come into this unit with the
7:07
incredible staff and doctors who
7:11
are trying to figure out
7:13
how to best help them.
7:14
Sandra Lindsay: I like what you said about you,
7:16
felt so hopeful afterwards,
7:18
because that's how I felt after
7:20
watching the episodes, hopeful,
7:23
especially when I saw the
7:24
patients leave in
7:26
Doctor Breeder,
7:28
how do you feel about
7:29
how it turned out?
7:31
Laura Braider: I am very happy with
7:33
how it turned out.
7:34
I think it achieved a lot of the
7:37
goals we set out to achieve
7:38
and some we didn't,
7:40
which was really cool about it.
7:42
I thought this could be a cool
7:46
way to destigmatize,
7:50
but also propagate knowledge.
7:53
Staff that doesn't typically get
7:55
highlighted were highlighted
7:57
by you, and that, for me,
8:00
was just really rewarding to see
8:04
people that are sort
8:05
of unsung heroes,
8:06
that nobody thinks about that
8:09
add and bring are such a part
8:11
of this journey to health,
8:13
but are not really thought of.
8:15
And for them to be highlighted,
8:17
I think, was so important for.
8:19
For the people that
8:20
have those jobs,
8:22
their colleagues at
8:23
the hospital,
8:23
but also for people who are
8:25
looking to go into mental health
8:27
to see that there's other areas
8:29
that you can be in to help,
8:31
and you don't necessarily have
8:32
to be a psychiatrist
8:33
or a psychologist.
8:35
Alexandra Shiva: It was also a really interesting
8:37
opportunity to be able to film.
8:39
And as doctor Rader said,
8:41
you don't often,
8:42
I don't think viewers
8:43
often see laypeople,
8:45
don't often see the work that
8:47
goes into mental health care.
8:48
And so often scenes played out,
8:52
really, on the staff,
8:54
not on the patients,
8:56
and sometimes on the patients.
8:57
But there was something really
9:00
fascinating and inspiring about
9:04
watching the staff do their jobs
9:06
and being able to capture that.
9:10
They are also trying to make
9:12
sure that everyone feels,
9:15
you know,
9:16
that everyone feels safe,
9:17
that everyone's not having
9:18
burnout, talking about burnout,
9:20
talking about the kinds of
9:21
issues that come up for them in
9:24
the work that they're doing.
9:25
We found the dichotomy between
9:27
what's happening with the
9:28
patients and what's happening
9:29
with the.
9:30
With the staff participants
9:31
fascinating.
9:33
Sandra Lindsay: Yeah, I saw that as well.
9:35
And we'll talk about the staff
9:37
a little later on.
9:39
I often say take special people
9:41
to work in this specialty, and,
9:44
you know, you could.
9:45
Just see it coming through.
9:46
Ultimately. Lindsay and Alex,
9:48
how did you decide what portions
9:51
of what you were filming
9:55
should be in the documentary?
9:58
Lindsey Megrue: Well,
9:59
we have two very brilliant
10:00
editors,
10:01
Toby Shimon and Ashley
10:02
Muradapore.
10:03
And so they were hugely
10:05
important to that process.
10:07
One of the other things that we
10:08
did is we conducted sort of exit
10:11
interviews with all of the
10:13
patient participants.
10:14
And so we had the opportunity to
10:17
listen to them about why they
10:18
wanted to participate and how
10:20
they framed their own stories.
10:22
And so we thought about that a
10:24
lot when we were editing
10:25
their stories. Like,
10:26
how did they want to be seen
10:28
and presented to the world?
10:29
And that was important to us.
10:30
So that was helpful knowledge,
10:32
even though we didn't end
10:33
up using the interviews.
10:35
Alexandra Shiva: And I think that at first,
10:38
we just wanted to meet all
10:40
of the patients that
10:41
were consenting,
10:42
that were eligible to consent,
10:43
that had then consented,
10:44
that were interested
10:45
in participating,
10:46
where we were getting people
10:47
at different stages,
10:49
sometimes the way that we work
10:50
is you have these very in depth
10:52
documentaries where you really
10:54
get to know three people.
10:56
And so the viewer is only
10:57
getting to know three people.
10:58
And what we knew pretty early on
11:00
is you're getting to know this
11:02
place because there is no way,
11:04
without intruding
11:05
on patient care,
11:06
we can't film every single
11:08
therapy session of one patient.
11:09
So it's a tapestry.
11:11
And we had the intake from one
11:14
person, from one patient,
11:15
and then, you know,
11:16
the med management scene with
11:19
another. And sort of,
11:20
you're picking up through this
11:22
patchwork how a patient moves
11:25
through their time on the unit
11:26
and gets and moves toward
11:28
health and wellness.
11:30
Sandra Lindsay: So let's get into the
11:31
group sessions.
11:32
So they're one on one session.
11:33
They're also group sessions
11:36
a term that is
11:38
used very often in the film.
11:41
Dialectical behavioral therapy,
11:44
or DBT,
11:46
and cognitive behavioral
11:48
therapy. Doctor breder,
11:49
can you just talk briefly about
11:51
those two types of therapies?
11:53
Laura Braider: Sure. So,
11:54
cognitive behavior therapy is
11:58
actually a group of therapies.
12:01
The basis of cognitive behavior
12:03
therapy is that we sometimes
12:06
have thoughts that are not true.
12:09
We have irrational cognitions
12:12
that happen in our head that
12:15
we don't even notice,
12:17
but they change how we behave,
12:19
and they change how we feel.
12:21
So the key is to finding out
12:23
what those thoughts are so we
12:25
can switch those thoughts to
12:27
change how we feel and
12:29
how we behave. Hence,
12:30
cognitive behavior therapy.
12:33
DBT stands for dialectical
12:36
behavior therapy.
12:37
And dialectical behavior therapy
12:40
is a treatment that was
12:43
originally created for patients
12:46
that are suicidal and has now
12:50
been developed to treat
12:54
emotion regulation and
12:58
relationship skills.
13:00
DBT consists of groups and
13:03
individual therapy.
13:05
So a lot of psychoeducation,
13:08
understanding how our brains
13:09
and emotions work,
13:11
those skills are what we're
13:12
really hitting home on the unit,
13:14
and that's a lot of the
13:16
therapy we're seeing,
13:17
because on the inpatient unit,
13:18
we were focusing on a lot of
13:20
patients with suicidality.
13:22
Sandra Lindsay: So, doctor Breda,
13:24
once a patient gets to,
13:26
once out,
13:27
how do you get to a diagnosis
13:29
and a treatment plan?
13:32
Laura Braider: Well,
13:33
I think the first part is we
13:35
really welcome them to the unit.
13:38
We give them a tour,
13:39
we help them navigate the unit.
13:44
We talk to them.
13:46
I think the first thing that you
13:48
have to do after that
13:49
is to listen.
13:51
Sometimes it's hard to ask for
13:53
help because they don't even
13:55
have the words to say what
13:57
they're asking help for.
14:00
Many times they don't know.
14:02
They know they feel really
14:04
bad or they don't feel well,
14:07
but they don't know
14:08
the exact terms.
14:09
They don't know that
14:10
it's anxiety,
14:11
they don't know if
14:12
it's depression.
14:14
They just know they
14:15
don't feel well.
14:15
So listening to them is the
14:17
first part thing assessing
14:20
as a team,
14:21
coming up with a diagnosis,
14:23
coming up with a treatment plan.
14:25
Sometimes that means medications
14:27
and medications can take time to
14:29
get to a therapeutic dose.
14:31
Then there's also the therapy
14:34
piece, there's psychoeducation,
14:36
helping the patient understand,
14:38
okay, this is what's happening,
14:39
and this is what it means,
14:41
and here's the trajectory and
14:43
the plan to go forward.
14:44
And almost always,
14:46
once we have a diagnoses and a
14:49
plan and therapy and treatment
14:52
were able to
14:54
provide hope. And that to me,
14:57
is the purpose of inpatient
14:59
hospitalization,
15:01
is to diagnose and then provide
15:05
that roadmap to provide hope for
15:09
a life worth living or a
15:11
meaningful life for that person.
15:13
Sandra Lindsay: But as we saw in the
15:15
documentary,
15:16
there was a patient that I can
15:18
remember that did not agree
15:20
with the diagnosis.
15:22
She thought she was fine,
15:24
and other patients may
15:26
feel that way.
15:27
So how do you handle situations
15:29
like these?
15:31
Laura Braider: Many times we have patients that
15:33
don't necessarily right away
15:36
buy into the diagnosis,
15:38
and that's okay.
15:39
Not always are people ready to
15:42
hear what we have to say,
15:45
and that's a process and
15:47
understanding that there's a
15:49
process to that and that we
15:51
can't just make somebody believe
15:54
what we're saying.
15:55
Sometimes we really have to
15:57
acknowledge that the patient is
15:59
doing the best they can
16:01
and still can improve.
16:03
Sandra Lindsay: Alex and Lindsay,
16:05
you captured the entire process
16:08
of from the patient Cayman
16:11
triage medications.
16:14
You captured the morning briefs,
16:17
the huddles.
16:19
Behavioral health is such
16:22
a sensitive area,
16:25
and the environment can be
16:28
volatile at times. How do you,
16:31
as filmmakers,
16:32
how did you approach this?
16:34
Lindsey Megrue: I think, you know,
16:36
you have these ideas of what
16:38
inpatient care looks like,
16:39
and certainly this is only one
16:41
very specific unit of.
16:43
But it was the opposite of what
16:45
you kind of classically
16:46
think of,
16:46
like those horror stories
16:48
from the sixties,
16:48
or one flew over the
16:50
cuckoo's nest,
16:50
like all of those kind of
16:52
media representations.
16:53
It was really the opposite of
16:54
that. I think, actually,
16:56
the surprising thing was how
16:57
often the unit was quite calm.
16:59
I mean,
17:00
it's not really a quiet place,
17:01
but there was.
17:02
I think everyone works
17:04
to keep the
17:07
level like it,
17:09
feeling calm and as healing and
17:11
relaxing as is possible.
17:13
But I think the other thing that
17:14
was important to us is,
17:15
you know, we're storytellers.
17:17
We want to make a film that is
17:19
watchable and entertaining,
17:21
while also educational.
17:23
But we were very careful not to
17:25
sensationalize what was
17:26
going on. I mean,
17:27
we didn't want to lead with the
17:31
sensational or, you know,
17:32
necessarily go towards
17:34
the volatile.
17:35
Its not what we were finding,
17:37
but we were also very careful as
17:39
to how we could include that in
17:40
the film because we didn't want
17:42
it to feel overly sensational.
17:45
Sandra Lindsay: Were there times where you
17:47
had to stop filming?
17:49
Alexandra Shiva: Yes, I mean,
17:50
there were definitely times.
17:51
Sometimes the volatility was
17:53
happening with, you know,
17:55
sort of out of our purview,
17:57
out of our view.
17:58
And sometimes it was we made
18:01
sure that all of the patients
18:02
knew that if anyone felt
18:04
uncomfortable at any moment,
18:05
they could say,
18:06
can you please turn
18:07
the camera off?
18:07
And that didn't happen
18:08
very often. And also,
18:10
we didn't really.
18:11
We didn't even capture an intake
18:13
until really close to the end
18:16
of our filming process.
18:18
And part of that was that when
18:20
you're making a film,
18:21
everyone has to get comfortable.
18:22
There's a comfort level that
18:24
everyone who is being
18:25
filmed has to have.
18:26
And that went for staff
18:28
and patients.
18:29
Everyones a person,
18:31
and everyone is having a human
18:33
experience to a camera crew,
18:35
even though we very small
18:36
footprint being in
18:38
their presence.
18:39
So it was quite complicated.
18:40
And so I think everyone finally
18:42
got comfortable and we started
18:45
to. We even had,
18:46
I have to bring up scheduled
18:47
spontaneity.
18:48
Lindsey Megrue: Oh, yes.
18:49
Alexandra Shiva: So these two favorite
18:50
Lindsay kept saying,
18:51
but we're getting the most
18:51
interesting footage when people
18:54
are just hanging out.
18:55
So they came up with scheduled
18:56
spontaneity together.
18:58
So every day there was 2 hours
19:00
at the end of the day of
19:01
scheduled spontaneity.
19:03
Doctor Breder had it down.
19:04
It was like you're scheduled
19:06
to be here,
19:06
then you're scheduled
19:07
to be there.
19:08
Lindsey Megrue: But it would.
19:08
What was really nice about those
19:10
moments was when it was just the
19:12
patients hanging out with each
19:13
other and a lot of the work was
19:15
actually happening
19:16
for them there.
19:17
And it was so nice to see them
19:19
connect and laugh and be silly
19:21
and just be regular
19:22
college students.
19:24
Sandra Lindsay: Yeah,
19:24
I remember some of those moments
19:26
when two patients,
19:27
they were sitting on the bed and
19:28
just talking and making.
19:30
Kind of like a promise to each
19:33
other. One was going home,
19:35
one was staying in. A promise,
19:37
I'll be safe on the outside,
19:39
but you also have to promise me
19:42
what you're going to do on the
19:43
inside. That was so touching.
19:45
I'm getting emotional, but,
19:47
yeah,
19:48
I think.
19:50
Laura Braider: That'S one of the most special
19:51
parts about having an inpatient
19:53
unit that specializes.
19:55
In college students,
19:56
because we're giving them
19:58
information that we
19:59
know is sound and.
20:01
Medically sound and
20:02
psychologically sound, but when.
20:04
You hear them saying it to each.
20:07
Other,
20:08
it just lands so much
20:11
more powerfully.
20:12
And I think that was,
20:15
if anything,
20:16
that I'm grateful for
20:17
about this film.
20:18
That is what I'm most grateful
20:20
for is that I'm hopeful
20:22
that people watching.
20:23
This will hear some
20:24
of the things.
20:25
That some of those patients
20:26
say and. That viewers,
20:28
it will land with them as well.
20:31
Sandra Lindsay: What do you hope viewers will
20:33
take away from one south?
20:39
Alexandra Shiva: I think hope and empathy
20:41
maybe certainly less
20:45
stigma around mental health,
20:48
around help seeking,
20:49
around if they know someone who
20:51
might need to need
20:54
inpatient care.
20:55
Not being afraid to go
20:56
look for a program,
20:58
someone just, you know,
20:59
even if they don't need that
21:02
level of care and they're not
21:03
in an acute situation,
21:04
just knowing that asking for
21:06
help is a really great.
21:08
It means you're strong.
21:10
It's a wonderful thing,
21:11
and just even taking that away
21:13
from it would be enough.
21:16
Sandra Lindsay: Lindsay?
21:18
Lindsey Megrue: We really hope that the film
21:20
will encourage a more open
21:21
conversation about
21:22
mental health.
21:23
It will normalize talking about
21:25
these things and also normalize
21:28
help seeking.
21:36
Sandra Lindsay: That does it for part one of
21:37
this episode. In part two,
21:40
we dive into more details on
21:42
what treatment looks like on a
21:43
psychiatric unit. Doctor Brader,
21:46
Alexandra,
21:47
and Lindsay reflect on various
21:50
skills that, once out,
21:52
staff use to help patients
21:53
cope and heal,
21:55
as well as how they
21:56
use it themselves.
21:58
From mindfulness to radical
22:00
acceptance,
22:01
you'll walk away with a deep
22:03
understanding of not only how
22:06
these patients and staff
22:08
benefited from them,
22:09
but how you may be able
22:11
to work these skills,
22:12
skills into your own life.
22:14
I want to thank Doctor Breeder,
22:16
Alexandra,
22:17
and Lindsay again for joining us
22:20
for this important conversation.
22:22
Onesouth is out now on HBO.
22:25
Max, until next time,
22:27
I'm Sandra Lindsay,
22:29
and this has been another
22:31
20 minutes. Health talk.