A Portrait of a Psych Unit at Zucker Hillside Hospital in Queens

Summary

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)

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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.

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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])

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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])

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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

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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.

Transcript

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[Alexandra Shiva]

All right, unk.

[Courtney (Dr. Laura Brater)]

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[Alison Stewart]

This is all of it on wnyc. I'm Alison Stewart and listeners, we want you to know that this Mental Health Monday segment will discuss suicide. If at any time you feel you need support, please call the National Suicide and Crisis lifeline. The number is 988. They are open 24 hours a day. Teens and young people in America have really been struggling with their mental health. A new HBO documentary shines a light on some of those young people here in Queens. Many who have strug with the lowest point in their lives. The days after a suicide attempt, the filmmakers embedded with One South, a psych unit for college students at Zucker Hillside Hospital. They followed young people from all different backgrounds and with all different kinds of problems as they worked with therapists and psychiatrists to determine what led them to consider ending their life and to try to develop new skills to help them cope in the outside world. Some patients are ready to receive help.

[Courtney (Dr. Laura Brater)]

Some.

[Alison Stewart]

Some are in denial that they need help at all. And many of them worry about what life will look like when they emerge from the unit. The documentary is titled One South Portrait of a Psych Unit and it's streaming now on Max and I'm Joined now by its directors, Lindsey Margrew and Alexandra Shiva, alongside one of the subjects in the film, Dr. Laura Brader, assistant vice president at Northwell Health and assistant professor of psychiatry at Donald and Barbara Zucker School of Medicine at Hofstra Northwell. Welcome to all.

[Lindsay Magrew]

Thank you so much for having us.

[Alison Stewart]

Lindsay, how did you and Alexandria get the idea to film in a psych unit specifically for college students?

[Lindsay Magrew]

Alexandra and I had worked on other films about mental health, and we felt like this was such a topic that needed more exploration. We started digging deeper with our research and realized that inpatient care really is the least understood and most stigmatized, and we wanted to focus on that. And then we found the One south program, which was just so unique. So we figured that that would be the best subject for the film.

[Interviewer/Host]

Dr. Brater, I am sure you had a lot of questions for the filmmakers who came to you with this idea. What kind of questions did you have for them, and why did you ultimately decide that this was a good idea?

[Courtney (Dr. Laura Brater)]

Sure, sure. Well, first of all, there was no world in which I was thinking I was going to do a documentary. When they approached us, that was the furthest thing from my mind. And when Alexandra called me, I just listened. I didn't think we were going to do anything. And also, she ended up. There was a lot of time that passed, but one of the questions, one of the things that concerned me was, could we do more harm than good by doing this? And my. That was my first inclination. And then she came back to me with a very. A question I'll never forget, because I didn't. I had never thought about it. But she said, you said you could do more harm than good. What would you do if you could do more good than harm? What would you do if you could. What if you had this platform? What would you want to tell all these people? That was a really interesting question for me. I thought about it. One of the things I get to see every day is young college students that are in their darkest moment go on in a pretty short amount of time to have hope and to be able to see a life worth living for themselves. I see how the peers and the interactions between each of them helps. And I think one of the things that crossed my mind at that time was, what if we could propagate this through a larger audience? What if this could be even bigger? And there were many concerns. There were a lot of things we had to work through, many conversations with our health system, who was very supportive of doing something like this in a in the right way. And so that's that. That's one of the reasons we did it.

[Alison Stewart]

Alexandra, what did the kids or young adults tell you why they agreed to be filmed?

[Alexandra Shiva]

Well, it was really interesting because one of the things that was really important to both Lindsay and myself was that we wanted to make sure that everyone's participation, once there was an entire consenting process, had nothing to do with us before we ever even met anyone, obviously. And then once we were engaged with consenting patients, it was conversations about it was very important that they were able to choose the level of participation that they wanted to have. So some people were only in group scenes. Some people were happy to have people in their. Have the film crew in their one on one therapy. Some people only wanted to be filmed from the back of their head and only their hands. There were certain, you know, dynamics. And so that was really important for us. And we did exit interviews with everyone that we filmed and we asked them, why did you participate? Why is this important to you? And the thing that overwhelmingly they said was that they wanted other people to know they weren't alone, that 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.

[Interviewer/Host]

Dr. Britter, we know young people in America are having a particularly hard time right now.

[Alison Stewart]

Is this a question of people are recognizing it and coming forward, or are we. Or has something shifted?

[Interviewer/Host]

Is it social media or is it both?

[Alison Stewart]

What do you think?

[Courtney (Dr. Laura Brater)]

I get that question a lot, and I think we are better at diagnosing things now, but we definitely are seeing more mental illness in general across the board. And the majority of the mental illness is in the area of depression or anxiety. In this case, in this documentary, we're depicting people that have become severely mentally ill or more mental and mentally ill enough to have to be in a hospital setting. I think that there's a number of things that go into why we might be seeing this mental health crisis. I think right now there's a lot of buzz around social media and bones, and that certainly is part of the problem. There is also a culture, and our culture and how we raise kids is very different than it used to be. I also think one of my biggest, the opportunity cost that comes with phones, not necessarily the phone itself being so demonized, but the fact that 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. And the example I could give is if you ask a college student to call and make a doctor's appointment, they may really bristle at the idea of making a doctor's appointment because they don't like making phone calls. They want to text someone.

[Interviewer/Host]

Right?

[Courtney (Dr. Laura Brater)]

So.

[Interviewer/Host]

And all that follows with that, someone comes. Comes to the staff. They're involved in an intake. Lindsey, when you filmed an intake session, which we get to see in the film, what stood out to you about the process?

[Lindsay Magrew]

I think what stood out of the process is how collaborative everything is on the unit. Every morning starts with what they call a team meeting. And there's really an entire team that runs the unit. 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. So I think the. In the intake, what I noticed most was that it was really about the entire team first checking in and then also debriefing afterwards. And in our film, you can see, you know, the social worker and psychiatrist were also present for that one. So it's. Everything on the unit really happens as a team effort.

[Interviewer/Host]

You're listening to our Mental Health Monday, and we're talking about the new HBO documentary One South Portrait of a Psych Unit, which follows college students spending time at a psychiatric unit in Queens. You can stream it now on max. Once again, we are talking about suicide. If you feel you need support, please contact the National Suicide and Crisis Lifeline. That number is 988. My guests are co director Alexandra Shiva and Lindsay Magru, as well as Dr. Laura Brater, Assistant vice president at Northwell Health. She's in the film as well. There's one patient that doesn't really think she belongs there. Dr. Brater. She really keeps insisting that she overdosed by accident. Again, how do you try to reach a patient who really feels they don't need help?

[Courtney (Dr. Laura Brater)]

That's. That's an interesting question, and that's a difficult one because every patient is so different. And you're really looking for this one spot where you might be able to get in. And with that particular patient, if I remember correctly, I was talking to her and she said, I don't need to be there. I don't want to be here. I. Everybody else needs to be here, but basically I don't. And at one point she said, I just have impulsivity. And that was like the one she threw me something that I had to latch onto. And I, at that point had said something about, you know, well, maybe that's the last Thing. Maybe just because you're here doesn't mean you aren't getting better. Maybe you are getting better, but this is one more thing you have to do in order to get the deal done or to be healthy. And I think it's so different. You're just looking for that one thing you can connect with somebody on. On whatever the level it is to be relatable. And all you have to do is give them a little hope. Most of the time, I'm telling our trainees, all we want to do is help someone, to think we might be able to help them.

[Alison Stewart]

In the film, there are a couple of moments which are captured, including one moment when a patient had to be sedated and restrained. Alexandria, what were those moments like for you? How did you decide what to film, what not to film, in high stress moments like that?

[Alexandra Shiva]

Well, I mean, we had very clear parameters around what we could film. And in that moment, it was clear that the story was the staff. And so we. We were within the guidelines of what we were able to film, and we focused in on the staff and their experience. So that's why you really see that scene play out through the staff. And as Lindsay had said earlier, they are all working together as a team. Everyone is checking in, figuring out how to support each other to best support the patient.

[Alison Stewart]

Lindsay, who is someone you saw who remarkably improved during the course of filming.

[Interviewer/Host]

That you really just were like, yes, they're gonna make it.

[Lindsay Magrew]

You know, I mean, I think everyone, to some extent, made a marked improvement. I think that that's why we focused on a unit that treats young people. You know, there's so much evidence that early intervention, you're gonna have better outcomes. But one patient, for example, and what Courtney, you know, she came in, hadn't been in therapy before, and, you know, was really able to make some progress and become. I think she in particular worked on things with her mom. You know, in the first scene, we meet her, she really is mentioning that she has a complicated relationship with her mom. And by the end, they've made a lot of improvement in being able to talk to each other. And a lot of that was because of the therapy that she was receiving on the unit. So I think that's a good example. One of the things that's amazing about this unit is that it focuses on dialectical behavioral therapy, which is a form of cognitive behavioral therapy, which Dr. Brader can talk about.

[Interviewer/Host]

My next question.

[Lindsay Magrew]

It's skill, space, and it's something that we could all use. So you see people using these skills throughout the film and you really get a moment as the audience to sort of learn them for yourself. And they're I think can apply to everyone. Mindfulness, radical acceptance. So we, we saw a lot of how the skills were positively impacting people as well.

[Interviewer/Host]

Dr. Brader, I was going to ask you to define DBT and also why have you found it to be the most effective with this group of patients?

[Alison Stewart]

This, this cohort?

[Courtney (Dr. Laura Brater)]

Sure. So dialectical behavior therapy, it's often called DBT is the gold standard treatment for a lot of what's depicted as the mental illness going on in this film. So most of the patients, or a lot of the patients have what's called borderline personality disorder, which can be. Can look like a lot of motion dysregulation, very, very high and low fluctuations in mood, maybe not being able to advocate for oneself in the best way. Sometimes you'll see in a person with borderline personality disord where they may actually be advocating for themselves but digging a hole or making things worse. Behaviors like suicidality, cutting self injurious behaviors would fall into that realm. And so that's what it treats. And those are difficult things to treat. And this is a, it's a psychoeducation and also a treatment where we teach skills in different areas. And they could be emotion regulation skills, they could be coping skills, they could be interpersonal skills. But there's a group of these, these skills that are taught. And one of the things that I loved about doing a film was how Alex and Lindsay referred to our skills. And at one point I saw them talking and they called it the DBT skills platter. Was that what it was?

[Alexandra Shiva]

It was when we were editing, we had our, our editors had a board and Dr. Brater had come to our office and we had the. It was called like a skills combo platter where we were doing like an interstitial. So that you see a little bit of what the skills are, what the skills are, but you're not delving in too much into one skill because for a viewer, you, it's, you know, we're not training you. We're not. This is not a DBT skills movie. It is a film that you're watching and then you were hopefully also understanding some of the skills.

[Courtney (Dr. Laura Brater)]

But I loved how they presented it. They were, they made it fun and they presented what we do in a, I think more palatable way where you can reach people differently than maybe a psychiatrist and a psychologist would.

[Alison Stewart]

Something. I noticed that even when sometimes these young people are in Their really dark moments of their lives. They're often able to have a sense of humor about things. Lindsay, what role do you think humor plays in one south and in the recovery process, from what you've observed?

[Lindsay Magrew]

It's essential. I mean, I think that that's one thing that we found in a lot of other films we've made. Even people at their darkest moments can find humor. And it's so, so reassuring to realize how resilient we are as people. And it was definitely one of the things that made a difference for the patients. I think where we saw that the most is when they were kind of just hanging out and being normal young people, playing cards, relaxing, listening to music and connecting. And I think that's when they were also able to help each other, which is a big part of the healing process.

[Alison Stewart]

Alexandra, what did the staff tell you about what keeps them motivated in very difficult and very demanding jobs?

[Courtney (Dr. Laura Brater)]

Well, I thought that was one of.

[Alexandra Shiva]

The most interesting things about being on the unit and filming was seeing the way that the staff took care of each other, that there really is a safety net around them, that they talk about burnout levels, that they actually have a time and a place to come and do their own DBT skills group modified. But to really talk about what kind of burnout, how they can help each other, other and, and then also their fears. I mean, they talk openly about their fears with patients, not specific patients necessarily, but the idea of what they're most afraid of. And, and that's a very interesting view for, for me and I think for the viewer into the therapeutic process because it's something that as the, as the layperson, we don't necessarily get to see often and we are able to show that in the film as well.

[Interviewer/Host]

Dr. Brater, what do you do to take care of yourself?

[Courtney (Dr. Laura Brater)]

Well, I love to be on the great South Bay. One of my favorite things is to be able to look at the water, watch boats going by. And one of the things that I do to take care of myself is learn something new or have a hobby. And, and I learned to boat last year. I took lessons from a captain two times a week. And I docked myself at Fire island this weekend.

[Interviewer/Host]

Well done.

[Courtney (Dr. Laura Brater)]

Very well done.

[Alison Stewart]

When you're looking to see if a patient can be released, Dr. Brater, what are you looking for before you decide someone is ready to re release?

[Interviewer/Host]

There's a young girl who thinks she's.

[Alison Stewart]

Going to get out, but it keeps getting extended longer and longer. What are you looking for?

[Courtney (Dr. Laura Brater)]

Well, we are one. We're looking to have them stabilized. So an inpatient unit is really for stabilization. An average length of stay is seven to 10 days. So we're looking to have somebody stabilize 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, and to maybe experience a trigger on the unit or experience something that is uncomfortable and see them have some sense of mastery over how they're going to manage it differently.

[Alison Stewart]

Lindsay, how do you hope that people will react to the film?

[Lindsay Magrew]

I hope it'll make it easier to talk about mental health. I just hope that it encourages a more open conversation, that young people feel more comfortable to talk to their friends, to their parents. Parents feel more comfortable to talk to young people and that we're also encouraging help seeking. If someone needs help, it's less scary.

[Interviewer/Host]

It can be stigmatizing to say I went to a psych unit. Alexandra, what do you hope the film helps with that?

[Alexandra Shiva]

Again, I think the destigmatization, I think that we're demystifying the process and I hope that it fosters empathy and a kind of understanding when people watch it that this is something that is that even if there's a, there's a relatability, even if someone doesn't necessarily need this kind of acute care, 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.

[Interviewer/Host]

One South Portrait of a Psych Unit can be streamed now on max. My guests have been co directors Alexandra Shiva and Lindsay McGrew as well as Dr. Laura Brater. Thank you so much for your time today.

[Alexandra Shiva]

Thank you so much.

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[Courtney (Dr. Laura Brater)]

I'm in.

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[Courtney (Dr. Laura Brater)]

Let's go.