Beyond Pathways to Care: Exploring the Role of Boundaries in Mental Health
DOI:
https://doi.org/10.18357/anthropologica67120252730Keywords:
mental health, care pathways, self-care, boundaries, higher education, CanadaAbstract
The Pathways to Care model is an increasingly popular method of healthcare delivery in institutional settings like higher education. Pathways are taken for granted as linear trajectories of care that are intuitive to navigate. However, care is often messy, diverse, and counterintuitive in practice. Set within the context of a Canadian university, students fill gaps generated by inadequate institutional Pathways to Care through self-care. Namely, students take up boundary-making as a generative and relational form of self-caring. Methods include social cartography and narrative accounting of care pathways by students supplemented by interviews with campus mental health stakeholders and providers. Results demonstrate that both pathways and boundaries can be limiting and potentiating in people’s search for support. Boundaries mediate emotional proximity and distance—or emotional emplacement—and in doing so generate new forms of intimacy, support, and healing. I advance theoretical conversations on the emplaced nature of care by documenting the role of self-care in people’s care journeys. I also forward social cartography as a fruitful avenue through which to understand the complexities of subjective experiences with care. These contributions amplify the voices of lived experience in understanding mental well-being in Canada.
Downloads
Publication Facts
Reviewer profiles N/A
Author statements
- Academic society
- Canadian Anthropology Society
- Publisher
- University of Victoria
References
ACHA: American College Health Assessment. 2016. Executive Summary, Canadian Reference Group: Spring. https://www.acha.org/wp-content/uploads/2024/07/NCHA-II_SPRING_2016_CANADIAN_REFERENCE_GROUP_EXECUTIVE_SUMMARY.pdf.(accessed 11 June 2025).
ACHA: American College Health Assessment. 2019. Executive Summary, Canadian Reference Group: Spring. https://www.acha.org/wp-content/uploads/2024/07/NCHA-II_SPRING_2019_CANADIAN_REFERENCE_GROUP_DATA_REPORT.pdf. (accessed 11 June 2025).
Ahmed, Sara. 2010 Selfcare as warfare. https://feministkilljoys.com/2014/08/25/selfcare-as-warfare/. (accessed 11 June 2025).
Anderson-Fye, Eileen P., and Jerry Floersch. 2011. “‘I’m Not Your Typical “Homework Stresses Me Out” Kind of Girl’: Psychological Anthropology in Research on College Student Usage of Psychiatric Medications and Mental Health Services.” Ethos 39 (4): 501–521. https://doi.org/10.1111/j.1548-1352.2011.01209.x.
Auerbach, R. P., J. Alonso, W. G. Axinn, P. Cuijpers, D. D. Ebert, J. G. Green, I. Hwang, R. C. Kessler, H. Liu, P. Mortier, M. K. Nock, S. Pinder-Amaker, N. A. Sampson, S. Aguilar-Gaxiola, A. Al-Hamzawi, L. H. Andrade, C. Benjet, J. M. Caldas-de- Almeida, K. Demyttenaere, S. Florescu, G. de Girolmo, O. Gureje, J. M. Haro, E. G. Karam, A. Kiejna, V. Kovess-Masfety, S. Lee, J. J. McGrath, S. O’Neill, B.-E. Pennell, K Scott, M. ten Have, Y. Torres, A. M. Zaslavsky, Z. Zarkov, and R. Bruffaerts. 2017. “Mental Disorders Among College Students in the World Health Organization World Mental Health Surveys.” Psychological Medicine 47 (15): 2737–2737. https://doi.org/10.1017/S0033291716001665
Bowlby, Sophie. 2012. “Recognising the Time—Space Dimensions of Care: Caringscapes and Carescapes.” Environment and Planning 44 (9): 2101–2118. https://doi.org/10.1068/a44492
Bowlby, Sophie, and Linda McKie. 2019. “Care and Caring: An Ecological Framework.” Area 51 (3): 532–539. https://doi.org/10.1111/area.12511.
Bowlby, Sophia, Linda McKie, Susan Gregory, and Isobel Macpherson. 2010. Interdependency and Care over the Lifecourse. Oxford: Routledge.
Bragato, Laura, and Kerry Jacobs. 2003. “Care Pathways: The Road to Better Health Services?” Journal of Health Organization and Management 17 (3): 164–180. https://doi.org/10.1108/14777260310480721.
Carney, Megan A., Debi Chess, and Michelle Rascon–Canales. 2022. ‘There Would Be More Black Spaces’: Care/Giving Cartographies during COVID–19. Medical Anthropology Quarterly 36 (4): 442–462. https://doi.org/10.1111/maq.12732.
Chambers, Ruth, Gill Wakley, and Alison Blenkinsopp. 2006. Supporting Self Care in Primary Care. Oxford: Radcliffe Pub.
CICMH. 2019. Centre for Innovation in Campus Mental Health. Stepped Care for Post- Secondary Campuses. https://campusmentalhealth.ca/wp-content/uploads/2019/09/Stepped-Care-Guide-V13.pdf. (accessed 11 June 2025).
Cincinnati Center for DBT. 2022. Boundaries Vs Limits. https://www.cincinnaticenterfordbt.com/boundaries-vs-limits/. (accessed 11 June 2025).
Cochrane, Logan, and Jon Corbett. 2020. “Participatory Mapping.” In Handbook of Communication for Development and Social Change, edited by Jan Servaes, 705–714. Singapore: Springer.
Cooke, Fadzilah Majid. 2003. “Maps and Counter-Maps: Globalised Imaginings and Local Realities of Sarawak’s Plantation Agriculture.” Journal of Southeast Asian Studies 34 (2): 265–284. https://doi.org/10.1017/S0022463403000250.
Cresswell, Tim. 2004. Place: A Short Introduction. Chichester: John Wiley and Sons, Incorporated.
Curtis, Sarah. 2016. Space, place and mental health. London: Routledge.
Duclos, Vincent, and Tomás Sánchez Criado. 2020. “Care in Trouble: Ecologies of Support from Below and Beyond.” Medical Anthropology Quarterly 34 (2): 153–73. https://doi.org/10.1111/maq.12540.
Duignan, Sarah, Tina Moffat, and Dawn Martin-Hill. 2022. “Be like the Running Water: Assessing Gendered and Age-Based Water Insecurity Experiences with Six Nations First Nation.” Social Science and Medicine 298: 114864–114864. https://doi.org/10.1016/j.socscimed.2022.114864.
Ebert, David Daniel, Philippe Mortier, Fanny Kaehlke, Ronny Bruffaerts, Harald Baumeister, Randy P. Auerbach, Jordi Alonso, Gemma Vilagut, Kaline U. Martínez, Christine Lochner, Pim Cuijpers, Ann-Marie Kuechler, Jennifer Green, Penelope Hasking, Coral Lapsley, Nancy A. Sampson, and Ronald C. Kessler. et al. 2019. “Barriers of Mental Health Treatment Utilization among First–year College Students: First Cross–national Results from the WHO World Mental Health International College Student Initiative.” International Journal of Methods in Psychiatric Research 28(2): e1782-n/a. https://doi.org/10.1002/mpr.1782.
Every, Nathan R., Judith Hochman, Richard Becker, Steve Kpoecky, and Christopher P. Cannon. 2000. “Critical pathways: A review.” Circulation: 101 (4): 461–465. https://doi.org/10.1161/01.CIR.101.4.461
Furr, Susan R., John S. Westefeld, Gaye N. McConnell, and J. Marshall Jenkins. 2001. “Suicide and Depression Among College Students: A Decade Later.” Professional Psychology, Research and Practice 32 (1): 97–100. https://doi.org/10.1037/0735-7028.32.1.97.
Gordon, Loa. 2024. “The Imaginarium of Self–care: Speculative Futures of Hope for Student Mental Health.” Medical Anthropology Quarterly 38(3): 285–297. https://doi.org/10.1111/maq.12868.
Green, Gill, Charlie Davison, Hannah Bradby, Kristine Krause, Felipe Morente Mejías, and Gabriele Alex. 2014. “Pathways to Care: How Superdiversity Shapes the Need for Navigational Assistance.” Sociology of Health and Illness 36 (8): 1205–1219. https://doi.org/10.1111/1467-9566.12161.
Harley, J. Brian. 1998. “Maps, Knowledge and Power.” In The Iconography of Landscape, edited by Denis Cosgrove, and Stephen Daniels, 51–81. Cambridge: Cambridge University Press.
Ivanova, Dara, Iris Wallenburg, and Roland Bal. 2016. “Care in Place: A Case Study of Assembling a Carescape.” Sociology of Health and Illness 38 (8): 1336–49. https://doi.org/10.1111/1467-9566.12477.
Kreys, Eugene D., and Jim M. Koeller. 2013. “Documenting the Benefits and Cost Savings of a Large Multistate Cancer Pathway Program from a Payer’s Perspective.” Journal of Oncology Practice 9 (5): e241–47. https://doi.org/10.1200/jop.2012.000871.
LaRochelle, L., and rudi aker. 2019. Boundaries as Invitation Rather than Limitation. https://lucaslarochelle.com/boundaries-as-invitation-rather-than-limitation/. (accessed 11 June 2025).
LeClerc, Chantale Marie, Donna L. Wells, Dorothy Craig, and Jean L. Wilson. 2002. “Falling Short of the Mark: Tales of Life After Hospital Discharge.” Clinical Nursing Research 11 (3): 242–263. https://doi.org/10.1177/10573802011003002.
MacDonald, Kathleen, Nina Fainman-Adelman, Kelly K. Anderson, and Srividya N. Iyer. 2018. “Pathways to Mental Health Services for Young People: A Systematic Review.” Social Psychiatry and Psychiatric Epidemiology 53 (10): 1005–1038. https://doi.org/10.1007/s00127-018-1578-y.
McKie, Linda, Susan Gregory, and Sophia Bowlby. 2002. “Shadow Times: The Temporal and Spatial Frameworks and Experiences of Caring and Working.” Sociology 36 (4): 897–924. https://doi.org/10.1177/003803850203600406.
Milligan, Christine, and Janine Wiles. 2010. “Landscapes of care.” Progress in Human Geography 34 (6): 736–754. https://doi.org/10.1177/0309132510364556.
Müller, Markus K., Konstantin J. Dedes, Daniel Dindo, Stefan Steiner, Dieter Hahnloser, and Pierre-Alain Clavien. 2009. “Impact of Clinical Pathways in Surgery.” Langenbeck’s Archives of Surgery 394 (1): 31–39. https://doi.org/10.1007/s00423-008-0352-0.
Nguyen, Vinh-Kim. 2010. The Republic of Therapy: Triage and Sovereignty in West Africa’s Time of AIDS. Durham: Duke University Press.
Nishida, Akemi. 2016. “Neoliberal Academia and a Critique from Disability Studies.” In Occupying Disability: Critical Approaches to Community, Justice and Decolonizing Disability, edited by Pamela Block, Devva Kasnitz, Akemi Nishida, and Nick Pollard. 145–158. New York: Springer.
Ogrodniczuk, John S., David Kealy, and Oliver Laverdière. 2021. “Who is coming through the Door? A National Survey of Self–reported Problems among Post– secondary School Students who have attended Campus Mental Health Services in Canada.” Counselling and Psychotherapy Research 21 (4): 837–845. https://doi.org/10.1002/capr.12439.
Oldenhof, Lieke, Jeroen Postma, and Roland Bal. 2016. “Re-placing Care: Governing Healthcare through Spatial Arrangements.” In Oxford Handbook of Healthcare Management, edited by Ewan Ferlie, Kathleen Montgomery, and Ann Reff, 415–433. Oxford: Oxford University Press.
Olsson, Lars-Eric, Elisabeth Hansson, Inger Ekman, and Jón Karlsson. 2009. “A Cost- effectiveness Study of a Patient-centred Integrated Care Pathway.” Journal of Advanced Nursing 65 (8): 1626–1635. https://doi.org/10.1111/j.1365-2648.2009.05017.x.
OSDHUS. 2021. Ontario Student Drug Use and Health Survey. Centre for Addiction and Mental Health. https://www.camh.ca/-/media/files/pdf---osduhs/2021-osduhs-report-pdf.pdf. (accessed 11 June 2025).
Pinder, Ruth, Roland Petchey, Sara Shaw, and Yvonne Carter. 2005. “What’s in a Care Pathway? Towards a Cultural Cartography of the new NHS.” Sociology of Health and Illness 27 (6): 759–779. https://doi.org/10.1111/J.1467-9566.2005.00473.X
Profitt, Norma Jean. 2008. “WHO CARES FOR US? Opening Paths to a Critical, Collective Notion of Self-care.” Canadian Social Work Review 25 (2): 147–168. https://www.jstor.org/stable/41669891
Rosenbaum, Susanna, and Ruti Talmor. 2022. “Self–Care.” Feminist Anthropology 3 (2): 362–372. https://doi.org/10.1002/fea2.12088.
——. 2024. “Toward an Anthropology of Self-Care.” Annual Review of Anthropology 53 (1): 199–214. https://doi.org/10.1146/annurev-anthro-041422-021833.
Savin-Baden, Maggi, and Katherine Wimpenny. 2014. A Practical Guide to Arts-related Research. Rotterdam: SensePublishers.
Sears, Alan. 1991. “AIDS and the Health of Nations: The Contradictions of Public Health.” Critical Sociology 18 (2): 31–50. https://doi.org/10.1177/089692059101800202
Spurgas, Alyson K., and Zoë Meleo-Erwin. 2023. Decolonize Self-care. New York: OR Books.
Sultana, Afroza, Julie Wilson, Dawn Martin-Hill, and Ashley Lickers. 2023. “Water Insecurity and Maternal Health Among Haudenosaunee Women in Canada.” Medical Anthropology 42 (6): 535–550. https://doi.org/10.1080/01459740.2023.2235629.
Student Wellness Centre. 2024. Accessing Counselling. https://wellness.mcmaster.ca/services/counselling/accessing-counselling/ (accessed October 2025).
Unruh, Kentot T., and Wanda Pratt. 2008. “The Invisible Work of Being a Patient and Implications for Health Care: “[the doctor is] my business partner in the most important business in my life, staying alive.” Ethnographic Praxis in Industry Conference Proceedings 1: 40–50. https://doi.org/10.1111/j.1559-8918.2008.tb00093.x.
Wiley, Adrianna N. 2023. “The Grind Never Stops: Mental Health and Expectations of Productivity in the North American University.” Anthropologica 65 (1): 1–24. https://doi.org/10.18357/anthropologica65120232035.
Wiley, Adrianna N. 2024. “A Continuum of ‘Normal’ Experience: Positioning Mental Health Struggles as Human Experiences in the University Context.” Ethos 52 (2): 324–337. https://doi.org/10.1111/etho.12422.
Wilson, Gracie. 2025. “‘If I’m not stressed, why am I even here?’: Exploring Narratives of Student Mental Health and Belonging on Campus.” Journal of American College Health: 1–10. https://doi.org/10.1080/07448481.2025.2486415.
Wood, Denis, and John Fels. 1992. The Power of Maps. New York: Guilford Publications.
Wylie, John. 2007. Landscape. Oxford: Routledge.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Loa Gordon

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Authors contributing to Anthropologica agree to release their articles under the Creative Commons Attribution-Noncommercial 4.0 Unported license. This licence allows anyone to share their work (copy, distribute, transmit) and to adapt it for non-commercial purposes provided that appropriate attribution is given, and that in the event of reuse or distribution, the terms of this license are made clear.
Authors retain copyright of their work and grant the journal right of first publication.
Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.