Heather Kinney

Community Engaged Project

Mag. and Dim. Globalization
Dr. Dolan
31. October 2014
Influence of Mental Health Facilities in South-central Pennsylvania
Globalization is one of the most frequently discussed and studied topics in todays
modern society. The developed world as we see it today would not exist without the expansion,
mixing, and creation of cultures throughout human history. One of the most critical aspects of
living in a globalized society is the ability to act as an interculturalistlearning to support and
thrive in a culturally diversified environment. To be successful in any field of work, one must
learn to be an interculturalist, just as Manfred Steger insists that multinational companies have
no choice but to transform themselves into global corporations (Greatest Hits, 3). Although
globalization and interculturalism play a vital role in all aspects of modern society, perhaps the
most important of these sectors is that of healthcare. Crucial across all parts of the world,
healthcare and its advances transcend national borders. Through observations conducted at the
Philhaven Mental and Behavioral Healthcare Center, I was able to experience first-hand the
importance of such institutions to the public, as well as better understand how the globalized
world helps these organizations make and impact on their society.
The mission statement of the Philhaven system of behavioral health is both simple and
powerful: Promoting Hope, Healing, and Wholeness. Not only does it portray a comforting

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message, but it does so in a way that indicates active striving to do so. The institution,
headquartered in Mount Gretna, operates in multiple counties across south-central Pennsylvania.
With many outpatient facilities and affiliations with other associations in the field of mental
health, such as IU-13, Children and Youth Services, and, most recently, Wellspan Health
Systems, Philhaven is the primary provider of mental health services. Between several offices in
Lancaster, Lebanon, Dauphin and York counties, the Mount Gretna facility is the only one to
offer inpatient services. Philhaven extends their services to those suffering from depression,
angry, violent, or abusive tendencies, and those who have been abused or neglected, and anyone
in the community can access outpatient counseling services. The system also provides for
businesses training through team-building workshops and summer programs. However, for a
person to enter the inpatient program, they must fall in one of three categories: dangerous to
themselves, dangerous to others, or inability to safely care for themselves.
The inpatient program I observed was that of the Child-Adolescent Unit, though
Philhaven operates an Adult Unit as well. When a patient is admitted into the unit, they are
placed on a level of orange, indicating they are to be closely monitored by staff. The first
procedure is for the patient to meet with a psychiatrist, which occurs daily up until their
discharge. The medical team that works with each patient consists of a psychiatrist, a medical
physician, a nurse case manager, a social worker who acts as a liaison to any other facilities or
professionals the patient is currently seeing, a therapist for family and individual sessions, the
floor nurses on duty, as well as psychiatric assistants who oversee group sessions and daily
activities. Patients are assigned to a roomconsisting of a bed, desk, and shelving unit
according to their age group. Most rooms are doubles, though patients who have experienced
sexual abuse or that are sexually fixated are assigned a single room. The life of a patient is very

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structured and monitored, and there are few items a patient may have in their dorm-style rooms.
Street clothing may not contain strings or laces, jewelry and piercings must be removed, and
even underwire bras are considered a potential hazard. Group sessions follow each meal: the first
session is dedicated to setting personal goals for the day, the second group focuses on developing
social skills and teamwork, and the evening group session reflects on the goals set that morning.
In addition to daily group and psychiatrist sessions, there is assigned gym time, visiting hours for
immediate family, as well as classwork relative to the childs grade in school.
Being a mental health facility, outbursts and negative behavior is a common occurrence
with some patients. The first order of action is to move the child into what is called the quiet
room, a soundproof room in which the patient and employee(s) involved discuss the incident.
Physical force, though fairly uncommon, is sometimes necessary to contain the child. For this
reason, when each patient is admitted, a document is made of all distinguishable marks on the
childs body, both so that they can be monitored for self-harm as well as protection for the staff if
a child accumulates injuries while in inpatient services. Disciplinary action results in loss of
privileges, such as being able to eat in the group cafeteria or having access to a radio. When such
action occurs, the patient is also moved down in the colored level system. Patients advance from
the orange level upon signing a safety contract with the attending physician, and move up
subsequent levels according to adherence to group participation, taking their medications, and
progress in individual counseling.
The staff at Philhaven, which ranges from entry-level positions to experienced medical
professionals, all have the same purpose: to help their patients. Throughout the observation, it
was apparent that this task can be more than difficult. Although many trained doctors and nurses
have training with patients of various backgrounds and ethnicities, the one improvement I would

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make to the facility would be mandatory training in the field of Intercultural Competence, as
cultural competence training in residency is important to improve learners confidence in crosscultural encountersrecognition of cultural diversity and avoidance of cultural stereotypes are
essential for health care providers (Medical Education Online). With an increasingly globalized
world comes a growing diversity of patients. It is important for medical professionals to not only
be educated of these differences, but also know how to properly engage with a variety of cultures
in a medical setting. There are different types of views people from various cultures have on
illness (Prof. Arnold Lecture, 2014). The biomedical approach, often called the Western
approach, is the most common in the United States and other developed countries, as it relies on
biological forces and the control they have over the body. Though this approach is what is taught
in medical schools, certain cultures follow other explanations for illness and disease. A magicoreligious approach states that health and illness are closely linked to supernatural forces, and
those mystical powers, typically outside of human control, cause health and illness. A holistic or
naturalistic approach is humans desire to maintain a sense of harmony with the forces of nature,
and illness is explained in systemic terms and occurs when organs in the body are out of balance
with some aspect of nature. Another important factor that needs to be taken into consideration
when dealing with a highly diverse society is a persons societal background: is the culture this
patient came from high- or low-context? A high-context culture would be one where time
orientation and meanings of certain situations are different from that in the United States and
those like it, known as low-context cultures. In a low-context culture, time is very structured and
strict schedules are valued. The outgroupwhere relationships are more transientis also more
valued than the ingroupwhen social rules make it easy to identify who is part of a specific

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group. Low-context cultures also rely on meanings to be clear and overt, while those in highcontext cultures imply meanings through social norms and values.
One article, A multi-method approach for cross-cultural training, describes the type of
processes suited for intercultural competency training in the medical field. The research team, of
which two are directors of internal medicine, one a professor of medicine, one a health educator
for Blue Cross Blue Shield, and one a diversity consultant for Blue Cross Blue Shield, designed a
six-fold process to stress intercultural competency in an internal medicine residency program.
Their week-long program set out to improve comfort with cross-cultural encounters, ability to
have dialogue about ones culture, increase awareness of healthcare disparities, and promote
collaboration with community through conferences, online seminars, group sessions,
multicultural gatherings, case-based programming, and presentations on intercultural
competence. Cultural knowledge, which consisted of four aspects of caring for culturally diverse
patients was improved in 92% of participants, cultural attitudes, encompassing comfort
interacting with five common differences such as religion, race, and language, improved in 93%
of participants, and cultural skills, including six requirements for interactions such as taking a
social history and negotiating treatment, improved in 93% of participants. Comfort in all of these
aspects is essential to effectively communicate with patients of varying cultures, and the
implementation of cross-cultural training significantly improves preparedness for these
situations. Overall, with intercultural competence and communication being a vital part of a
successful medical practice, such training would be highly advised of all employees.
Through working with the mental health professionals of the Philhaven health systems, I
feel like I have gained a broader appreciation for those coping with these disorders, as well as
those who strive to help them. I witnessed first-hand the circumstances in which mental illnesses

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and abuse can put a person in. The experience at Philhaven was both enlightening and rewarding,
as I feel through encountering the companys goals and practices, I have come to better
understand how vital these institutions are to those who struggle in our society.
The field of medicine is vital in all societies around the world, because medical teams and
advancements transcend the boundaries of nation-states. Medicine and globalization go hand-inhand, as those in the medical field learn to thrive in a culturally diversified environment. Being
successful in the field of medicine is grounded on being interculturally competent, which traces
back to the increasingly globalized and modernized world. Without globalization and the
expansion, mixing, and creation of cultures, the medical field would not have advanced to the
state we know it to be today.

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Works Cited
Class Lectures. Dr. Dolan. Global Studies 101: Magnitudes and Dimensions of Globalization.
Fall 2014.
Class Lectures. Prof. Arnold. Sociology 240: Diversity and Intercultural Communication. Spring
2014.
Community Experience. Philhaven Behavioral Health Systems. Child Adolescent Unit. Mt.
Gretna, Pennsylvania.
Staton, L., Estrada, C., Panda, M., Ortiz, D., & Roddy, D. (2013). A multimethod approach for
cross-cultural training in an internal medicine residency program. Medical Education
Online. 28 October 2014.
Steger, Manfred B. Globalization: The Greatest Hits: A Global Studies Reader. Oxford: Oxford
UP, 2010. Print.