Help-seeking is defined as an act of actively and intentionally seeking help from other people; it involves discussing personal matters with another person for guidance and support [2],[25]. The sources of help are formal – such as people who have a professional degree in a relevant course – and informal, such as trusted people, including parents or friends (ibid). Adlaf [1] and Grotan [12] argued that mental health problems are higher among university students than in the general population due to challenging changes that happen when adolescents transition to young adulthood. The transition is characterised by overwhelming life-changing experiences that affect financial, social, and emotional aspects of life and put post-secondary students at a higher risk of mental disorders [23], [19].
Several studies discussed mental health problems' impact on students' performance. According to the International Board of Credentialing and Continuing Education Standards when students are experiencing depression or anxiety, their mental capacity focuses on creating worrisome thoughts that exhaust them [13]. This process detracts their learning abilities by weakening memorisation and concentration, making it hard for them to acquire new knowledge and cope with examination situations, which eventually results in poor academic performance [12]. Additionally, depressive disorders are associated with reduced cognitive function, lack of interest in others, and physical symptoms such as nausea, high blood pressure, fatigue and lowered mood, which sometimes push students to miss classes [30],[17]. These studies detailed how mental illness negatively affects students’ performance and their learning abilities.
Despite the prevalence of mental health problems among college students, the frequency of professional help-seeking is low. An epidemiological study conducted among six Canadian postsecondary institutions revealed that while 80% of students felt mentally disturbed, only 15.4% sought professional help for their mental health disorders[10]. Bantjes [4] also reported a low utilisation of campus mental healthcare services among South African students despite how well-resourced these services were. Some research findings highlighted that young people with emotional problems were more likely to seek help from trusted people in the community [28]. However, a study from Australia mentioned that even though seeking support from trusted and close people can provide emotional and informational support, it comes with the disadvantage of receiving uninformed information, which might not provide the full support in need [11].
The reported barriers to seeking professional help among college students were peer pressure, stigma, less information about campus counselling services, negative previous experiences, and long waits experienced when students want to meet campus counsellors [5],[10]. Ibrahim [14] found self-stigma to be the most substantial barrier to seeking professional mental health support because seeking help is perceived as a sign of weakness and acceptance of failure, which sabotages self-esteem. According to the Mental Health Foundation, 9 out of 10 people with mental disorders experience stigma, and it comes in two forms: public stigma and self-stigma [18],[7],[34]. Public stigma comes from society's reaction to mental illness, while self-stigma is the prejudice people put on themselves [8].
This review looked into various aspects of mental help-seeking among college students. While university students were revealed to be a high-risk group to mental issues, there is limited literature on formal help-seeking patterns among that group in low-income settings. Moreover, no previous studies looked into students' attitudes toward campus-based mental health services in Rwanda, such services being one of the means to seek help for that group.
This study aimed to assess college students' perceptions and behaviour on professional mental health help-seeking and examine their attitudes towards campus-based mental healthcare services. The study was guided by the following research questions: (1)Which perceptions and behaviours do college students have towards formal help-seeking? (2)What are the students’ attitudes towards campus-based mental health care services?
Methods of Data Collection
This study employed mixed research methods to understand and assess university students’ help-seeking perceptions, and attitudes towards formal help. The participants were college students from 15 Rwandan universities with all academic years represented. Most of the previous papers that worked on similar topics had defined populations; however, the current study targeted an unknown population and used Cochran's formula that enabled the calculation of the minimum sample size for the unknown population. The sample was estimated to be 150 respondents derived from a 95% confidence interval and 8% acceptable margin of error as detailed below [27]:
Due to the sensitivity of the topic and COVID-19 social distancing regulations, data was collected anonymously and virtually. An online survey was created using Google form; it consisted of closed-ended and open-ended questions to understand why respondents picked particular choices. Most of the previous studies used quantitative methods; however, the current study added a qualitative aspect (open-ended questions) to get an in-depth understanding of formal help-seeking behaviours [2],[14]. Some of the survey questions were derived from pre-designed questionnaires meant for mental health research purposes, such as the General Help-Seeking Questionnaire [14]. The link to the survey was shared with participants randomly via WhatsApp, Emails and Google Hangouts.