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Alison Stewart: This is All Of It on WNYC. I'm Alison Stewart. 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 struggled 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. Some are in denial that they need help at all. 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.

I'm joined now by its directors, Lindsey Megrue and Alexandra Shiva, alongside one of the subjects in the film, Dr. Laura Braider, 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.

Lindsey Megrue: Thank you so much for having us.

Laura Braider: [unintelligible 00:01:38].

Alison Stewart: Lindsey, how did you and Alexandra get the idea to film in a psych unit specifically for college students?

Lindsey Megrue: Alexandra and I had worked on other films about mental health, and we felt like this was such a topic that needed more exploration, and so 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. 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.

Alison Stewart: Dr. Braider, 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?

Laura Braider: Sure. 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. When Alexandra called me, I just listened. I didn't think we were going to do anything. Also, she ended up-- there was a lot of time that passed. One of the things that concerned me was, could we do more harm than good by doing this? That was my first inclination, and then she came back to me with a question I'll never forget because 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, and 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. 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? 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 the right way. 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: It was really interesting because one of the things that was really important to both Lindsey and myself was that we wanted to make sure that everyone's participation-- There was an entire consenting process that had nothing to do with us before we ever even met anyone, obviously. 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. Some people were only in group scenes. Some people were happy to 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 dynamics. That was really important for us. We did exit interviews with everyone that we filmed. We asked them, "Why did you participate? Why is this important to you?" 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.

Alison Stewart: Dr. Braider, we know young people in America are having a particularly hard time right now. Is this a question of people are recognizing it and coming forward, or has something shifted? Is it social media or is it both? What do you think?

Laura Braider: 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 illnesses 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 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 phones, 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 things is 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. 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.

Alison Stewart: And all that follows with that. Someone 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?

Lindsey Megrue: 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. I think the intake, what I noticed most was that it was really about the entire team first checking in and then also debriefing afterwards. In our film, you can see the social worker and psychiatrists were also present for that one. Everything on the unit really happens as a team effort.

Alison Stewart: 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 Lindsey Megrue as well as Dr. Laura Braider, 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. Braider. 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?

Laura Braider: That's an interesting question, and that's a difficult one because every patient is so different. You're really looking for this one spot where you might be able to get in. 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. Everybody else needs to be here, but basically, I don't." At one point she said, "I just have impulsivity." That was the one she threw me something that I had to latch onto. I, at that point, had said something about, "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."

I think it's so different. You're just looking for that one thing you can connect with somebody 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. Alexandra, 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: 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 were within the guidelines of what we were able to film, and we focused in on the staff and their experience. That's why you really see that scene play out through the staff. As Lindsey 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: Lindsey, who was someone you saw who remarkably improved during the course of filming that you really just were like, "Yes, they're going to make it."

Lindsey Megrue: 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. There's so much evidence that early intervention, you're going to have better outcomes, but one patient, for example, Courtney, she came in, hadn't been in therapy before, and was really able to make some progress and become-- I think she in particular worked on things with her mom. In the first scene, we meet her, she really is mentioning that she has a complicated relationship with her mom.

By the end, they've made a lot of improvement and being able to talk to each other and a lot of that was because of the therapy that she was receiving on the unit. 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. Braider can talk about.

Alison Stewart: My next question. [laughs]

Lindsey Megrue: It's skills-based, and it's something that we could all use. You see people using these skills throughout the film and you really get a moment at the audience to learn them for yourself. They, I think, can apply to everyone. Mindfulness, radical acceptance. We saw a lot of how the skills were positively impacting people as well.

Alison Stewart: Dr. Braider, 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, this cohort.

Laura Braider: Sure. 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. Most of the patients, or a lot of the patients have what's called borderline personality disorder, which can look like a lot of motion, dysregulation, 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 disorder 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.

That's what it treats. Those are difficult things to treat. It's a psychoeducation and also a treatment where we teach skills in different areas. They could be emotion regulation skills, they could be coping skills, they could be interpersonal skills, but there's a group of these skills that are taught. One of the things that I loved about doing a film was how Alex and Lindsey referred to our skills. 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, our editors had a board, and Dr. Braider had come to our office, and we had the-- It was called a skills combo platter, where we were doing an interstitial so that you see a little bit of what the skills are, but you're not delving in too much into one skill, because for a viewer, we're not training you. This is not a DBT skills movie. It is a film that you're watching, and then you are hopefully also understanding some of the skills.

Laura Braider: I loved how they presented it. 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 or 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. Lindsey, what role do you think humor plays in One South and in the recovery process from what you've observed?

Lindsey Megrue: It's essential. 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 reassuring to realize how resilient we are as people. 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 just hanging out and being normal young people, playing cards, relaxing, listening to music, and connecting. 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?

Alexandra Shiva: I thought that was one of 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, and then also their fears. They talk openly about their fears with patients, not specific patients, necessarily, but the idea of what they're most afraid of.

That's a very interesting view for me and I think for the viewer into the therapeutic process because it's something that, as the layperson, we don't necessarily get to see often, and we are able to show that in the film as well.

Alison Stewart: Dr. Braider, what do you do to take care of yourself?

Laura Braider: 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. One of the things that I do to take care of myself is learn something new or have a hobby. 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.

Alison Stewart: Well done. Very well done. When you're looking to see if a patient can be released, Dr. Braider, what are you looking for before you decide someone is ready to be released? There's a young girl who thinks she's going to get out, but it keeps getting extended longer and longer. What are you looking for?

Laura Braider: One, we're looking to have them stabilized. An inpatient unit is really for stabilization. An average length of stay is 7 to 10 days. 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, 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: Lindsey, how do you hope that people will react to the film?

Lindsey Megrue: 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.

Alison Stewart: 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 even if 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 stigmatized.

Alison Stewart: One South: Portrait of a Psych Unit can be streamed now on Max. My guests have been Co-Directors Alexandra Shiva and Lindsey Megrue as well as Dr. Laura Braider. Thank you so much for your time today.

Laura Braider: Thank you.

Alexandra Shiva: Thank you so much for having us.

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