The Prevalence of Attitudes toward Seeking Counseling Help among Malaysian University Students

Previous literature indicates that the studies on counseling service utilization among Malaysian university students remain scarce. Therefore, this study is conducted aiming to identify the attitude of the Malaysian students in the university in their effort to seek for counseling assistance. The next aim is to identify the extent of the difference in attitude in getting counseling services as demonstrated by respondents according to their gender. A total of n=810 students from a public university in Selangor agreed to become the respondents voluntarily. The respondents were chosen using the simple random sampling. The data collection was done using the Attitudes toward Seeking Professional Psychological Help instrument (ATSPPH). A descriptive analysis was used to examine the attitudes of university students toward seeking counseling help. The result indicates that the majority of the respondents’ attitude is still negative in terms of meeting the counselor and obtaining counseling service. Based on the findings obtained, several suggestions have also been put forth at the end of the discussion.


Introduction
Due to the increased urbanization and globalization, the lives of the people today have become more daunting and complex. The challenges are rooted from the drastic changes that take place in the economy, social, politics, science and technology, also culture and life demands. This kind of change will, in the end, create various psychological and psychosocial problems, not only to the individuals, but also to the society as a whole (Marzuki, 2016) especially among university students. Mental health is crucial for university students' wellbeing and their ability to adapt with challenges both in university and life (Pheng et al., 2019). Khan et al (2009) highlighted common problems such as academic failure, examination stress, relationships and family problems as significant factors contribute to depression among university students in Malaysia. This is a critical problem because persistent mental illness can ruin students' academic performance and overall life potentials (Pheng et al., 2019). Therefore, counselling becomes a significant service in promoting better mental health among the general population (Pandya & Lodha, 2021;Sun & Su, 2020).
Counselling had various approach and techniques to assist clients in coping with psychological distress and mental health problems. Nowadays, a lot of parties begin to show their confidence in counselors as a new beacon of hope to them in helping to address conflicts they face in various settings and situations. Numerous studies reported on the advantages of counseling (Pheng et al., 2019). Counselling can be described as a psychological and psychosocial help as well as mental health services. The Code of Ethics of American Counseling Association (ACA, 2014) defined counseling as "a professional relationship that empowers diverse individuals, families, and groups to accomplish mental health, wellness, education, and career goals." In Malaysia, counseling has formally been introduced in the beginning, in Malaysian schools, in the sixties (Salim, 2010). Counselling service has been helping to place humanity in the national education system since the 1960s. MARA Technology Institute has become the first higher education institution that offers counselling service to students at university level (Higher Education Ministry Malaysia, 2013). The institution has paved the way for other universities to follow suit such as Universiti Malaya, Universiti Kebangsaan Malaysia and others which later on, had provided the counselling service so that students can be assisted in any way, on campus (Rohany, 2008).
Next, the counselling service in Malaysia has been acknowledged as a professional field with the enactment of Act 580, Counselor Act 1998 where every counselor wishing to provide service needs to register with the Counselor Institution and is in possession of a Certificate of Practice. The acknowledgment has caused the increased number of registered counselors every year in this country. The statistics shows that 6025 counsellors had passed and obtained their license as Registered Counsellor in July 2015 (Marzuki, 2016). The total number continued to increase in March 2015 to 8083 registered counsellors (Lembaga Kaunselor Malaysia, 2019).
The counseling profession in Malaysia has been growing rapidly in recent years after over 60 years of history. Nonetheless, this is very upsetting as the real situation prevalent among the Malaysian universities and colleges students is that counseling services are greatly underutilized, despite the high need for them (Salim, 2010). Thus, the first step in making counseling service function more effectively among university and college students begins by understanding the students' attitude in getting counselling help.

Problem Statement
Previously, the studies concerning mental health issues among Malaysian university students are growing (e.g. Salim, 2010;Azizan et al., 2013;Khan et al., 2010). Recently, a study among Malaysian university students depicts that the majority of the respondents experienced depression by having negative feelings, feeling anxious and stressed, experiencing mouth dryness, and finding it difficult to become enthusiastic (Hassan et al., 2022). Meanwhile, in a study by Kamaluddin et al (2020), around 30% of the university students were reported to experience some level of anxiety due to the COVID-19 pandemic.
According to Hassan et al (2022), this is a serious problem because persistent psychological distress can impair students' academic achievements and their well-being life in overall. The depression, anxiety and any kind of stressful symptoms experienced by university students must be given greater attention and immediate treatment. Mental health is a crucial aspect in university students' life. They need a good mental state to be able to cope with challenges in the university specifically and in life generally. However, if they have a mental problem and they are not well treated, there will be numerous negative consequences such as a decrease in the academic performance as well as poor health (Hassan et al., 2022).
In the effort to curb this issue, the counseling service is empowered as a psychological support platform to help those in need through the Eleventh Malaysia Plan 2016-2020 (RMK-11, 2015). Unfortunately, previous literature indicates that there is a service gap between students with psychological distress and those who actually seek counseling. While recent study has shown an increase in the number of research in people's attitudes toward seeking counseling help, there is a paucity of this topic in the Malaysian context. Therefore, this study is conducted to determine the type and level of Malaysian university students' attitudes when seeking for counselling help.

Literature Review
Chen et al (2020) conducted a study to investigate the attitudes and factors in seeking counselling help among a Chinese community-dwelling population in order to promote positive help-seeking behaviors and better utilization of mental health services. Their study involved n=912 community-dwelling residents. The data were collected among the respondents regarding their attitudes toward seeking counselling help, depression symptoms, family function, depression literacy, help-seeking intention, and stigma. The finding indicates the overall respondents' attitude toward seeking counselling help is not optimistic and still at low rate even they had the depression symptoms, family function and depression literacy. Pheng et al (2019) probed into the relationship between stigma (public stigma, close-others stigma, and self-stigma) and attitudes toward seeking counselling, and the prediction factors of attitudes toward seeking counselling among students from a public university in Malaysia. The analysis then revealed that there is a significant negative relationship between every type of stigma and attitudes toward seeking counselling. Among the three types of stigmas, the self-stigma is indicated as the significant predictor of attitudes toward seeking for counselling.
Another local study by Salim (2010), investigated the readiness of counselling help-seeking attitudes among Malaysian university students. The questionnaire used was Attitudes toward Seeking Professional Psychological Help (ATSPPH) from Fisher and (Turner, 1970). The statistical tool employed was the t-test, aiming to see the difference in attitude in getting counselling help among males and females. The study outcome established that a majority of Malaysian students rarely seek for help with low score category, whereas the second is moderate score and the least is the highest score. The mean for all four sub-scales also is in the low category. There is a significant difference between the sample of attitude between men and women, but there is no significant difference in ethnic groups.
Recently, Topkaya (2021) has conducted a study of counselling help-seeking attitudes among Turkish college students. Data were analyzed using the Pearson product-moment correlation coefficient analysis and the multiple linear regression analysis. The results suggested that being female, being older, having previous help-seeking experience, as well as lower levels of anticipated risks, self-stigma, self-esteem, and self-rated health and higher levels of anticipated benefits were associated with positive help-seeking attitudes among college students. Next, the study done by Wong (2012), identified the factors that influence illegal motor-racing or also known as the culture of mat rempit. 2022 samples of mat rempit nationwide had taken part in the study. It is revealed that the majority of the samples have a very low desire and have a negative belief in getting counselling help. A total of 77.9% stated that they would rather solve their problems themselves.
The study carried out by Khan et al (2009) aimed to identify the attitude, complications and prevention on depression also the obstacle in getting counseling help among the ethnic groups in Penang, Malaysia. A total of 1855 respondents who had participated were from the simple random sampling. The finding revealed that 79.2% agreed that their family and friends can reduce their depression through care and attention. There are three obstacles on the attitude among those who are depressed. The first one is that they do not know about the depression risks they are facing. Secondly, they do not realize the existing signs and symptoms, and finally they have no desire to share the problems they are facing. From the findings from previous studies, it shows that the level of seeking counselling help attitudes is still low. However, when it comes to Malaysian university students, the findings of that attitude it is still lack. Therefore, this study is conducted to fulfil the gap in the past literature regarding the attitudes toward seeking counselling help.

Methodology
This study is a quantitative method using a descriptive design. This study is carried out in a University Putra Malaysia in Selangor. Prior to the study, researcher had obtained the approval of the university department and faculty to conduct the study. A total of n=900 respondents was selected using the simple random sampling technique. Before the questionnaire was distributed, all the respondents were contacted by phone. The call was made to inform them about the study that was to take place, to get their agreement and to confirm that the respondents' hostels are the same with the information provided by the university's administration. Respondents were allocated half an hour to fill in the questionnaire given. The questionnaire was distributed to n=900 respondents, but only n=810 respondents had successfully returned the document.
The study involves the use of Attitudes toward Seeking Professional Psychological Help (ATTSPH) Instrument (Fischer and Turner, 1970) carrying 29 items. ATTSPH is built to see the extent of one's desire to get help from a professional offering some psychology-based services. In this study, the psychology services intended are counseling services. This instrument has 29 items using the four-point Likert scale (0=Strongly Disagree, 1=Slightly Disagree, 2=Slightly Agree, 3=Strongly Agree). There are 11 items of positive statements (2, 5, 7, 11, 12, 16, 18, 23, 25, 27, and 28) and 18 items of negative statements (1, 3, 4, 6, 8, 9, 10, 13, 14, 15, 17, 19, 20, 21, 22, 24, 26, and 29). The negative items need to be recoded before the total scores are calculated. Refer to Table 1 below for the items and method of calculating the scores.  3,4,6,8,9,10,13,14,15,17,19,20,21,22,24,26,29 0 1 2 3 3 2 1 0 Based on Fischer and Turner (1970), there are four categories based on the total scores obtained. The minimum scores of 0-28 is at the lowest level, where it shows that individuals do not believe in counseling help, scores 29-49 is at the low level, representing individuals' attitude that doubts counseling help, whereas scores 50-63 show individuals having moderate level of attitude and being neutral about it, and 64-87 shows high level and individuals have a positive attitude when it comes to getting counseling help. Researcher had also conducted the content validity analysis process for this ATTSPH instrument and it was discovered that all the items were appropriate and thus, should be retained. A pilot study was also carried out (n=30) with the reliability value (α) = .823. Table 2 shows the distribution of the number of respondents based on gender. The descriptive analysis shows that a total of 313 people (38.6%) are male students, while 497 people (61.4%) are female students.  Table 3 shows the number of respondents based on their level of attitude in getting counseling help. The study result shows that 20 people or 2.5% are at the level of not believing in counseling help. The majority of the respondents are at low level, or they are in doubt about counseling help (567 respondents or 70%), followed by moderate level 196 people or 24.2%, and high level 27 respondents or 3.3% only. All in all, the study outcome proves that the inclination of university students to get counseling services is still low. The results of this study have increased the understanding regarding the attitudes toward seeking counselling help or mental health services among the Malaysian university students. The results depict that majority Malaysian student in higher institutions still not ready to get counselling services. The study outcome is consistent with that of Pheng et al (2019); Salim (2010), where many students in Malaysian institutions of higher learning who experience academics, personal, vocational, social or psychological problems do not seek help from counselors. Both studies are consistent to establish that the majority of the respondents are still in doubt about getting help from counselors, making them stay at a low level. Other than that, the findings of this study are also in line with the other outcomes from Wong (2012) and Khan et al (2010) although the studies targeted at different groups. All the respondents from these two studies indicate they will not seek for counselling services even had the problems.

Result and Discussions
This reflects the fact that counseling service is still at a weak level among Malaysians, especially students at the university level. This is due to the fact that students do not really believe in the counseling services provided. This lack of belief in the counseling service is explained by the lack of knowledge in the service (Pheng et al., 2019;Salim, 2010). One of them stems from self-stigma (Pheng et al., 2019). Self-stigma related to counselling help is one of the most significant avoidance factors in using mental health services (Vogel et al., 2006). Self-stigma occurs when the individual internalizes their culture's negative stereotypes and form of negative belief toward mental illness and help-seekers (Topkaya, 2021).
Counselling is often pictured as a place for those who have problems and need to be assisted. Some even believe that seeing a counsellor implies a sign of weakness and one's failure (Fisher & Turner, 1970). The negative belief toward the behavior of getting counselling help will eventually shape the negative assumptions or reactions on counselling service. Previous studies have depicted that self-stigma is correlated with a decreased likelihood of engaging in activities related to mental health, including seeking counselling help (Lannin et al., 2016).
Other than that, Khan et al (2009) proposed that there are three main obstacles on the attitude to get counseling help among those suffering from depression. The first obstacle is that they do not know about the depression risk that they are facing, secondly, they are not aware about the existing signs and symptoms of depression, and finally they have no desire whatsoever to share their problems. Thus, due to all three factors, they do not seek for any counseling help although in reality, it is crucial that they do so.
Next, some other things that contribute to the formation of attitude to get counseling help among students are factors like gender (Topkaya, 2021). Female students are more inclined to get help compared to male students. The study done by Topkaya (2021) revealed that university students who have previous help-seeking experience, as well as lower levels of anticipated risks, self-stigma, self-esteem, and self-rated health and higher levels of anticipated benefits will tend to develop a better and attitude and believe in counseling service.
Furthermore, the attitude of getting counseling help is also determined by the subjective norm which explains how far one possesses the motivation to follow the advice of the significant people in their lives. According to Wong (2012), in the collectivist society and with the family orientation in Malaysia, the decision to get counseling service is influenced by family members, close relatives and friends. The decision does not only come from themselves but also it explains why the attitude of seeking for help among the students remains at an all-time low.
Meanwhile in the Chen et al (2020), from the previous literature they found that the attitudes toward seeking counselling help actually can be influence by numerous factors such as gender; age; educational level; marital status; work status; sociological and cultural factors such as culture prejudice; social support; mental health literacy; individual factors such as stigma related to mental problems; help-seeking intention; the experience of mental problems; knowledge about the role of health professionals; and personality traits.

Conclusions and Recommendations
An attitude like this must be changed and all relevant parties like the counselor, lecturer, and the university itself need to think of various initiatives to create a more positive desire and view on the counseling service. If there is no effort at all, the implication is such that the students will continue to avoid from meeting the counselor and will be reluctant to get help although they suffer from issues like mental disturbance. Indirectly, this will give a risk to the increase in various unanticipated issues. All the findings and implications have been presented and elaborated in the discussion above. For future studies, it is suggested that the link between the factors seen to have contributed to the formation of attitude in getting counseling help among university students in Malaysia, is accounted for. Apart from that, other factors that have yet to be identified, that can surely contribute to the variables, would be another aspect worth exploring.