Podcast Summary

Podcast: All Of It with Alison Stewart (WNYC)

Episode: A Portrait of a Psych Unit at Zucker Hillside Hospital in Queens
Air Date: July 8, 2024
Guests:

• Lindsay Magrew (Co-Director, "One South: Portrait of a Psych Unit")
• Alexandra Shiva (Co-Director)
• Dr. Laura Brater (Assistant Vice President at Northwell Health, Assistant Professor of Psychiatry, and featured in the documentary)

Episode Overview

This episode of All Of It focuses on the new HBO documentary One South: Portrait of a Psych Unit, which offers an unprecedented look inside the One South psych unit at Zucker Hillside Hospital in Queens. The unit specializes in treating college-aged young adults recovering from suicide attempts, depression, and severe anxiety. Host Alison Stewart is joined by the film’s directors and Dr. Laura Brater to discuss the making of the documentary, the realities faced by these young patients and staff, and the stigmas and challenges surrounding inpatient psychiatric care.

Key Discussion Points & Insights

The Genesis and Intention Behind the Documentary

How the Documentary Came to Be

• Filmmakers Lindsay Magrew and Alexandra Shiva, both previously involved in films addressing mental health, wanted to demystify and destigmatize inpatient psychiatric care—especially for young adults. They settled on the One South unit due to its unique focus on college students.
  • “We realized that inpatient care really is the least understood and most stigmatized, and we wanted to focus on that.” (Lindsay Magrew, [03:09])

Dr. Brater’s Initial Concerns and Breakthrough

• Dr. Brater wasn’t initially interested, worried about potential harm:
  • “Could we do more harm than good by doing this?”
  • Alexandra Shiva reframed the conversation:
  • “What would you do if you could do more good than harm? What if you had this platform?” (Dr. Brater, [03:50])
  • This question catalyzed her involvement, realizing the potential to spread hope and reduce stigma.

Consent, Patient Privacy, and Participation

Allowing Patient Choice

• Alexandra recounted a careful, multi-layered consent process, allowing patients to control the extent of their participation:
  • Some only appeared in group scenes, some agreed to 1:1 sessions, some only filmed from the back.
  • The team conducted exit interviews—most participants sought to help others feel less alone:
    • “They wanted to demystify, destigmatize what was going on for them, that they had felt the kind of community there that they wanted other people to understand was possible.” (Alexandra Shiva, [06:10])

The Mental Health Crisis Among Young Adults

Is the Crisis Worsening? What’s Changed?

• Dr. Brater acknowledges both increased recognition and a real rise, particularly in depression and anxiety.
  • “We definitely are seeing more mental illness in general across the board… There’s a lot of buzz around social media and phones… But our culture...how we raise kids is very different than it used to be.” (Dr. Brater, [07:42])
  • Phones and screens often crowd out developmental experiences.
  • “The opportunity cost that comes with phones… it keeps our attention for so long and it precludes other things that are so important for young people to experience in order to develop appropriately.” ([07:42])

Inside the Psych Unit: Teamwork and Treatment

Collaboration Is Key

• Lindsay describes seeing intake sessions and daily team meetings:
  • “Every morning starts with… a team meeting… There are psychiatrists, psychologists, social workers, nurses, mental health workers. Even the custodial staff is actually really integral to the flow and the working of the unit.” (Lindsay Magrew, [09:46])

Approaching Patients in Denial

• Dr. Brater points out the nuance in reaching those who claim they don’t need help:
  • “You’re just looking for that one thing you can connect with somebody on… All you have to do is give them a little hope.” (Dr. Brater, [11:21])

Filming Sensitive Moments

What to Show and What Not to Show

• During high-stress incidents, like patient restraint, filmmakers focused on staff reactions:
  • “We focused in on the staff and their experience… They are all working together as a team. Everyone is checking in, figuring out how to support each other to best support the patient.” (Alexandra Shiva, [13:10])

The Role of Therapy: DBT

Dialectical Behavioral Therapy (DBT)

• The primary modality at One South:
  • “DBT is the gold standard treatment for...borderline personality disorder… It’s a psychoeducation and also a treatment where we teach skills in different areas… emotion regulation, coping, interpersonal skills.” (Dr. Brater, [15:29])
• Filmmakers presented therapy skills likened to a “DBT skills platter,” aiming to make them accessible for all viewers.
• DBT skills like mindfulness and radical acceptance are woven throughout both the film and the lived experiences of the patients.

Humor, Peer Support, and Resilience

Humor as a Healing Force

• Lindsay notes the resilience shown by young people, their use of humor, and peer support:
  • “It’s so reassuring to realize how resilient we are as people… When they were hanging out… playing cards, relaxing, listening to music and connecting… they were also able to help each other.” (Lindsay Magrew, [18:25])

The Needs of Staff: Preventing Burnout

• Staff at One South care for each other, process fears, and hold modified DBT groups for themselves.
  • “There really is a safety net around [the staff]... [They] talk about burnout levels… and their fears… it’s a very interesting view into the therapeutic process.” (Alexandra Shiva, [19:10])

Recovery, Discharge, and Measuring Readiness

What Signals Readiness for Discharge?

• The goal in inpatient care is stabilization:
  • “We’re looking to have somebody stabilized to understand what’s going on in their brain, to be able to understand what happened and also know what they would do differently if that happened again.” (Dr. Brater, [20:58])
  • Typical stay is 7–10 days.

Hopes for Audience Impact

Reducing Stigma, Encouraging Openness

• Lindsay hopes the film makes talking about mental health easier:
  • “I hope it’ll make it easier to talk about mental health… that young people feel more comfortable to talk to their friends, to their parents…” (Lindsay Magrew, [21:48])
• Alexandra frames the film as demystifying and fostering empathy:
  • “I think that we’re demystifying the process and I hope that it fosters empathy… there is a broad range of the human experience that they can see aspects of their own experience in it and that it isn’t, it isn’t stigmatized.” (Alexandra Shiva, [22:18])

Notable Quotes & Memorable Moments

• Dr. Laura Brater on agreeing to the film:
  “What would you do if you could do more good than harm? What if you had this platform?” ([03:50])
• Alexandra Shiva on patient motivation:
  “They wanted other people to know they weren’t alone, that they wanted to demystify, destigmatize what was going on for them...” ([06:10])
• Lindsay Magrew on the power of teamwork:
  “The entire team runs the unit… everything on the unit really happens as a team effort.” ([09:46])
• Dr. Brater on treatment approach:
  “You’re just looking for that one thing you can connect with somebody on… All you have to do is give them a little hope.” ([11:21])
• Dr. Brater on DBT:
  “It’s a psychoeducation and also a treatment where we teach skills in different areas... There’s a group of these skills that are taught.” ([15:29])
• Lindsay Magrew on humor:
  “Even people at their darkest moments can find humor. And it’s so, so reassuring to realize how resilient we are as people.” ([18:25])
• Alexandra Shiva on staff support:
  “There really is a safety net around them… to talk about burnout… and also their fears.” ([19:10])
• Dr. Brater (on self-care):
  “One of my favorite things is to be able to look at the water, watch boats going by… I learned to boat last year.” ([20:08])
• Lindsay Magrew on hopes for the film:
  “I hope it’ll make it easier to talk about mental health… that we’re also encouraging help seeking. If someone needs help, it’s less scary.” ([21:48])

Timestamps of Important Segments

• [03:09] – How the documentary idea originated
• [03:50] – Dr. Brater’s decision to participate and core ethical considerations
• [06:10] – Patient consent and reasons for participating
• [07:42] – Societal/cultural changes and the mental health crisis
• [09:46] – Inside a psych unit: teamwork and intake sessions
• [11:21] – Compassionate approaches to patients in denial
• [13:10] – Filming during moments of crisis and focus on staff
• [15:29] – DBT explained and its role at One South
• [18:25] – The importance of humor and peer connection
• [19:10] – Staff burnout and internal support mechanisms
• [20:08] – Dr. Brater’s personal self-care
• [20:58] – Criteria for releasing a patient
• [21:48] – Hopes for the film’s social impact
• [22:18] – Film’s role in destigmatizing mental health treatment

Final Thoughts

This episode provides a transparent and empathetic look at a rarely-seen aspect of mental health—young adults in inpatient psychiatric care. Through direct testimonial from filmmakers and clinicians, listeners gain insight into the collaborative, skill-based, and human-centered approach of units like One South. The documentary One South: Portrait of a Psych Unit aims to foster empathy, reduce stigma, and encourage open conversation about mental health struggles and recovery among young people and their communities.