CASE STUDY
Katelynn E. Kaestner*, Sarah M. Larkins*, Savannah G. Rodgers*, and Randy Hamm⁺
School of Health Sciences, Barton College, Wilson, NC, USA
*Student author, ⁺Faculty mentor
CITATION
Kaestner, Katelynn E.; Larkins, Sarah M.; Rodgers, Savannah G.; & Hamm, Randy. (2026). Mindful horizons: A mental health wellness center proposal for Nashville, NC. Barton Journal, 1(1), 120–126. https://bartonjournal.org/vol-1-no-1/2026-cat2-article-no-008
Abstract
Mental health remains a significant yet often overlooked issue in the United States. In rural towns such as Nashville, North Carolina, limited resources and few clinics intensify the problem. Nashville’s primary clinic, Primary Care and Urgent Care of Nashville, cannot prescribe psychiatric medications, resulting in patients having to seek help at emergency departments and causing treatment delays. To examine these issues, this study utilizes descriptive research methods and case study analysis, as well as scholarly articles, a windshield survey, and descriptive observations to identify gaps in mental health services. The windshield survey gathered firsthand information from local community members, drawing on all five senses: taste, sight, smell, sound,, and touch. Cross-referencing resources and community findings showed that a business proposal foundation for Nashville, NC, would be beneficial. This proposal consists of building a mental health wellness center to address the mental health crisis in the small town of Nashville, NC, and providing individuals with proper treatment and medication administration.
Keywords: mental health, health care, nursing
Introduction
Untreated mental health is a very serious topic in many communities; however, the solution lacks available resources. Mental health can be affected by many things, such as an individual’s socioeconomic status, physical health, and substance abuse. In the 2021-2022 Nash County Community Health Needs Assessment, behavioral health was named as one of the top three areas of priority. It was stated that the issue should be addressed by community engagement to understand the issue, resources provided to improve it, and progress progress tracked (Hill et al., 2022)
While conducting the research in the community of Nashville, NC, the findings suggested a significant need for mental health services in the community, and that an intervention could be made by providing the community with a mental health clinic. This clinic would be placed in a vacant building in the downtown area of the community and would consist of mental health nurses, office managers, therapists, and a psychiatrist. It would also provide a variety of mental health services, such as cognitive behavioral therapy, group and individual therapy sessions, and classes to teach participants how to heal and maintain a healthy mental status.
It was evident that mental health was a very important topic and that there are currently no resources available directly in the Nashville community for mental health treatment. There is also no access to public transportation in the community, meaning that personal transportation to surrounding communities is the only access the community has to mental health care services.
The purpose of this research project was to address as many mental health needs in the community as possible to improve the overall mental health status of the community. The local facility will provide the community with easier access to treatment. If constructed correctly, the facility should cause a decrease in mental health crises within the community over a period of time.
Context and Background
The research took place in the rural area of Nashville, North Carolina. This area consists of an urgent care facility for medical treatment and a pharmacy for pharmacological needs. However, the urgent care is not able to provide treatment or medication for mental health conditions. They also have to provide a referral to a different cities’ facilities in the event of a mental health crisis. Because of the lack of mental health services, members of the community must travel to the surrounding communities of Wilson, North Carolina, or Rocky Mount, North Carolina, for mental health treatment. This serves as an issue for community members with no means of transportation because Nashville lacks access to public transportation systems.
The lack of mental health services serves as an issue for a large variety of stakeholders. First, there are a large number of community members affected by mental health diagnoses. No local mental health treatment means that community members do not have direct access to the resources necessary to sustain a healthy mental status. There is also a financial barrier due to the cost of traveling to surrounding communities to receive care, and a burden to families or caregivers of mental health patients in the area. Because there are no local services, caregivers have to take on a larger role in the maintenance of mental health diagnoses, especially in the case of mental health crises. Because the caregiver is also required to ensure that these patients have transportation to receive care, this increases the chances of caregiver strain.
Not only does the lack of mental health care cause strain on patients and families, but it also causes an increased strain on medical services in the community and surrounding areas. First, it serves as a strain on the urgent care and primary care providers within the community. With the lack of mental health services, community members go to their primary care or urgent care to seek treatment for mental health. This causes an unnecessary increase in patient visits and increases the strain on providers to make the proper referrals. The mental health of the community also affects the health care services in surrounding communities. One example of this is the increase in mental health crises seen in surrounding emergency departments. If mental health services were available in Nashville, emergency departments at UNC Nash and Wilson Medical would likely see a decrease in mental health patients.
Case Description
When discussing mental health in rural areas such as Nashville, NC, there were some common mental health medications found from using the Windshield Survey. Some common medications were prescribed in Nashville, according to workers at CVS Pharmacy in Nashville, NC. These common medications consisted of antipsychotic medications for schizophrenia and “hormonal” medications. When in rural care, many individuals with a mental health illness often go unnoticed or do not get the proper treatment, as there are not enough resources available for them. Within Nash County, 20% of individuals indicated that they were unable to receive mental health care due to the high cost and insurance, 19% indicated that they lacked the knowledge of where to go, and 10% did not have the time to go (HECSC, 2024). When looking into substance abuse, alcohol was the highest-ranked health issue in the survey, which led to concerns about alcohol usage, prescription drug misuse, and individuals coping with substance use (HECSC, 2024). Concluding the review of commonly prescribed medications in Nashville, NC, and the county’s overall approach to mental health, it is evident that these factors significantly impact individuals’ well-being.
At Nashville’s “Primary Care and Urgent Care of Nashville,” the Nurse Practitioners indicated that when patients come in for psychiatric help that includes medication, they should be referred to the nearest hospital, Nash General Hospital in Rocky Mount, NC. The clinic in Nashville is roughly 10 minutes away from the hospital. However, mentally ill patients who are not at risk of harming themselves or others tend to wait hours to be seen, Emergency Departments identify in triage which patients need to receive care first (Kurhayati et al., 2025). This can cause individuals to push away from wanting to obtain help because the waiting hours can be unbearable for some, such as those with schizophrenia, who can experience their symptoms escalating and cause poorer thinking and processing skills (Mayo Clinic, 2024), leading to one leaving the emergency room before being seen. This is due to their symptoms, such as their psychosis, causing them to lose sight of reality (Mayo Clinic, 2024). With the delay of treatment, individuals’ symptoms can worsen, which makes it difficult for them to perform daily activities or hold a job, and can eventually lead to death by suicide (Mayo Clinic, 2024). Mental illness is a chronic condition and needs constant treatment and medications prescribed to help the individual maintain their daily activities and be able to function independently. However, as mentioned previously, individuals struggle to afford or lack the resources to get the help they need.
Alternatively, with further research, establishing a for-profit mental health wellness center can specifically help these individuals get the care they need. These outpatient services can help individuals receive proper treatment and medications when the right team is assembled. The right team will include a psychiatrist, as they are allowed to prescribe psychiatric medications that are beneficial for mental health illnesses. There is evidence that factors in the physical environment reported as beneficial include sensory design elements, such as colors around the individual, sounds, and textures (Sui et al., 2023). These sensory designs, such as the plant colors “green, light green, white-green, green-yellow, and green-red” (Sui et al., 2023), have been shown to reduce stress levels in an individual’s everyday life (Kexiu et al., 2021). Not only that, but these plant colors have shown a correlation with positive feelings, including “calmness, comfort, and naturalness” (Kexiu et al., 2021), which suggests that these colors can have a positive impact on relaxation and emotional status (Kexiu et al., 2021). Next, engagement qualities that serve as a distraction, such as crafting (Sui et al., 2023) and art therapy, have been shown to help mental health as it is a way for individuals to express themselves, which will then help improve not only their mental health but also their interpersonal relationships (Shukla et al., 2022). The third benefit is the social relationship aspects, including privacy and connection (Sui et al., 2023). An environment that helps individuals feel they have their own personal space and are not in a crowded area can help decrease negative emotions such as anxiety or feelings of exposure (Sui et al., 2023). Lastly, affective experiences are the space itself, as this environment needs to have the individual feel “safe, calm, in control, self-aware, or creative was beneficial” (Sui, et al., 2023).
Overall, a positive environment that is patient-centered for individuals with mental health illnesses can improve their well-being. Implementing different types of therapy, such as Art Therapy, can also help individuals’ mental health, by improving their depression through self-expression or helping with schizophrenia with what they are seeing through their hallucinations or delusions. Along with providing a sense of calm and a place of security, it also offers opportunities for emotional regulation and finding better ways to cope.
Analysis
The case of limited mental health access in Nashville, North Carolina, can be effectively interpreted through several public health and nursing frameworks, including the Social Determinants of Health (SDOH) and the Health Belief Model (HBM). These frameworks provide a comprehensive way to understand the barriers identified in the community. They also help support the rationale for establishing a local mental health wellness center. The Social Determinants of Health framework highlights how environmental and socioeconomic factors influence health outcomes (WHO, 2023). In this case, key determinants such as limited transportation, financial constraints, and lack of local healthcare infrastructure impact access to mental health services. The absence of public transportation creates a geographic barrier, while financial limitations and lack of insurance further restrict people’s ability to seek care. The SDOH principles emphasize that health inequities are often rooted in systemic issues rather than individual choices. This directly reflects the findings discovered during this case study. The proposed wellness center directly addresses these disparities by improving geographic accessibility and potentially reducing financial strain associated with travel.
The Health Belief Model helps explain why individuals in the community may delay or avoid seeking mental health care (Alyafei & Easton-Carr, 2024). According to the HBM, health behaviors are influenced by perceived susceptibility, severity, and barriers, along with cues to action. In Nashville, individuals may recognize the severity of their mental health conditions, but are discouraged by long wait times in emergency departments, cost, or the lack of knowledge about available resources. There is also stigma surrounding mental illness that may further reduce perceived benefits of seeking care. Establishing a local wellness center can act as a “cue to action” by increasing awareness, reducing stigma through community engagement, and making services more approachable and accessible. Additionally, the concept of patient-centered care is evident in the proposed design of the clinic (Edgman-Levitan & Schoenbaum, 2021). Research supports that therapeutic environments, including calming sensory elements and opportunities for creative expression, can improve mental health outcomes. By integrating these features, the wellness center aligns with holistic nursing principles that address not only psychological needs but also environmental and emotional well-being.
Systems theory can be applied to understand the broader impact of the intervention (Komashie et al., 2021). The lack of mental health services affects multiple interconnected systems, including families, primary care providers, and regional hospitals. By introducing a local wellness center, this “intervention” has the potential to reduce strain on emergency departments and enhance overall community health outcomes. Applying these frameworks demonstrates that the mental health challenges in Nashville are complex and require a comprehensive intervention. The wellness center is supported by established public health and nursing theories, making it a practical and evidence-based solution to address the identified gaps in care.
Implications
The findings from this case study have significant implications for public health practice, healthcare delivery, and community-level interventions in rural settings. Addressing the identified gaps in mental health services in Nashville, North Carolina, highlights the critical need for increased accessibility, affordability, and awareness of care. The implementation of a local mental health wellness center could reduce healthcare disparities by minimizing transportation barriers and alleviating the burden on emergency departments and primary care providers. Furthermore, integrating patient-centered and evidence-based approaches, such as cognitive behavioral therapy and therapeutic environmental design, may improve treatment adherence and overall outcomes. These implications also extend to policy development, emphasizing the importance of funding and resource allocation for rural mental health infrastructure. Strengthening community partnerships and increasing mental health education can reduce stigma and encourage early intervention. This case underscores the necessity for interdisciplinary collaboration among healthcare providers to ensure comprehensive and continuous care for individuals with chronic mental health conditions. Future research should evaluate the long-term effectiveness of such interventions in similar rural communities to inform sustainable healthcare models and improve population health outcomes.
Conclusion
The findings from this case study illustrate the impact that limited access to mental health services can have on individuals and communities, particularly in rural areas such as Nashville, North Carolina. The lack of local resources, transportation barriers, financial constraints, and limited awareness creates a system in which many individuals are unable to receive timely and appropriate care. As a result, mental health conditions often go untreated or worsen over time. This can lead to increased reliance on emergency departments and added strain on families and healthcare systems.
This case highlights broader lessons about the importance of accessibility and early intervention in improving mental health outcomes. Communities with limited infrastructure require targeted, locally driven solutions that address both systemic barriers and individual needs. The proposed mental health wellness center demonstrates how integrating patient-centered care, community engagement, and evidence-based practices can create a more effective and sustainable model of care. Additionally, the case emphasizes the need to view mental health through a holistic lens, recognizing the influence of social, economic, and environmental factors on overall well-being. Ultimately, this case reinforces the importance of investing in rural healthcare systems and prioritizing mental health as a critical component of public health. By applying established frameworks and tailoring interventions to community-specific needs, similar rural areas can work toward reducing disparities, improving access to care, and fostering healthier populations.
References
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