Counselling Services Utilisation in a Malaysia Private University

University can be an exciting yet challenging transition for students. Many universities provide counselling services to students who need it during their tertiary studies but many students tend to avoid counselling. This study was conducted to identify the counselling service experience among undergraduate students. The emphasis was on the past experiences, awareness, attitude and perceived barriers on the intention and utilisation of the counselling services. This study found that past experiences, awareness and intention to use has a significant relationship with utilise counselling services within their universities. On the contrary, attitude and perceived barriers to admission is not comprehended as a factor to seeking counselling. These determinants are useful reference for university counsellors for their planning and implementation to create further awareness of their counselling sessions for their students.


Introduction
Guidance and counselling services is able to improve academic achievement, enhance personal development (Oluremi, 2014), solving vocational, personal-social problems of students and decision-making (Salami, 1998).Dean and Meadows (1995) define university counselling is able to provide counselling services to students within the setting of a specific environment.Nevertheless, whether students use counselling facilities or not is another question (Salami, 1998).Being a university student, he or she often faces various pressure and difficulties (Morgan & Robinson, 2003;Ercan, 2010) that could disturb the acquisition of their educational and career goals (Morgan & Robinson, 2003).The problems experienced by university students inclusive of the education, family, personality, sexual, generational conflict, future expectations, finances, unemployment, drug abuse, depression and also psychological problems (Ercan, 2010;Flansburg, 2012;Salim, 2010).For instance, most of the students live apart from their households, trying to make new friends or gain financial responsibilities could make them feel insecure and stressed (Cebi, 2009).
Relatively, the international students often deal with these problems because they travelled from one country to another to gain knowledge (Rai, 2002).Therefore, they have to cope and do adjustment for handling different cultures, isolation feelings and anxious (Hyun, Quinn, Madon, & Lustig, 2007).Those challenges faced by the international students, including language barriers, culture barriers, social isolation, financial hardships and difficulties in searching jobs post-graduation (Hyun et al., 2007).In fact, distressing psychological symptoms can be reduced if students are willing to seek and welcome help from any counsellor (Ciarrochi & Deane, 2001).In fact, the undergraduate students have negative views towards counselling and psychotherapy such as uncomfortable, upsetting, risky and generally tough for them to engage in (Flansburg, 2012).On the other hand, Muema and Killu (2013) argued that counselling allows students to build a friendly relationship with the pleader.By holding this relationship, it is convenient for counsellor to identify and understand more in depth about the problems facing by the students.Simultaneously, counselling able to facilitate the students to realize the long lasting effect meanwhile the students has the freedom to speak and realize their consequences and actions.
People tend to avoid seeking help when they have mental health issues even when help is readily available (Atkinson, 2007).Most people who usually face psychological issues deals it by themselves or seek help from their friends, kin or community members rather than seek assistance from professional counsellors (Maki & Kitano, 2002).The use of counselling services in Malaysia is limited even though it was comprehended as an important service to the school community (Chai, 2000).A sum of 16.6% of Malaysia's secondary students utilized the counselling services for their mental and emotional problem (Kok, Low, Lee, & Cheah, 2012).Whereas, there was a low percentage of university students seeking the assistance of career counselling service (Rashid, Hussin, & Putih, 2005).In the United Kingdom, the demand for counselling services on campuses has dramatically risen by 33% since 2008 (Froio, 2013) while Malaysia still faces low percentage in utilizing counselling services.College can be an exciting yet challenging transition for many college students in which they may face negative emotions such as lost, lonely, confused, stressed, and anxious (Nilsson, Berkel, Flores & Lucas, 2004).These problems may lead to depression.In addition, untreated depression is the elemental factors that cause of suicide for college scholars.The suicide rate in Malaysia is increasing, particularly among the new people (Kok & Goh, 2012).According to the National Suicide Registry Malaysia (NSRM), there was an average of two people a day who has committed suicide in the year 2011.Generally, young people between the age of 16 to 24 years, females and Indians had the highest risk of suicidal behaviour (Doksil, 2012).Since undergraduate student's needs, personality development, orientations, development of a career plan are only impressed by the services given in the centres (Koydemir-Özden & Erel, 2010).Therefore, this work points to define the past experiences, consciousness, attitude and perceived barriers to access of counselling services.Secondly, it targets to identify the correlation and differences of past experiences, consciousness, attitude and perceived barriers to accessing counselling services with the aim to use counselling services among students between local and international students.Yorgason, Linville, and Zitzman (2008) reported that between 30% and 60% of the American college students were actually unaware or unsure regarding the availability of campus mental health services.Further, there are only 14% of the respondents know exactly where their university's counselling centre is.The students always misconstrued university counselling services as career guidance counselling.The attitude toward seeking psychological help is a learned predisposition to respond in a favourable or an unfavourable manner with the psychological help-seeking (Cebi, 2009).Aloud (2004) indicated that individual who views counselling services positively is likely to seek a counsellor when he/she is facing psychological problem.However, according to previous literature, attitude toward counselling services can be understood from the perspectives of gender, self-disclose and stigma.

Literature Review
Numerous studies have consistently found on the gender differences in attitude toward seeking counselling services.Women were more receptive and have higher positive attitudes compared to men (Lopez, Melendez, Sauer, Berger, & Wyssmann, 1998;Vogel, Wade, Wester, Larson, & Hackler, 2007;Greenidge, 2007).For instance, Kano (city in Nigeria) female students in tertiary institutions preferred to seek help from expert guidance in resolving their problem while male students' preferred non-expert guidance (Kolo, 1994).Men who refuse to seek counselling services do not mean that they are free from emotional disturbance and problematic life, instead they are facing gender role conflicts (Sharpe & Heppner, 1991).The reasons are males have been educated to ignore their feelings and not showing their emotion or else will be regarded as a "feminine" (Boisijolie, 2013).Notably, women expect to have a more positive outcome from the counselling than men (Brown, 2011).Whereas, the new university students feel inappropriate to self-disclose any information with new friends (Hinson & Swanson, 1993) as they felt such disclosure would bring damages in forming a relationship or existing stressed relationship (Bernier, Larose, & Soucy, 2005).An individual that has a feeling of uneasiness or less comfortable when talk about personal issues with a counsellor is five times less likely in help-seeking from any counsellor (Diala, 2000).
In fact, the college students are reluctant to disclose their personal information with a stranger or feel fearful or embarrassed if their social circle notice that they are seeing a therapist.According to Flansburg (2012), there are two stigmas exist which are public stigma and self-stigma.Self-stigma is defined as the reduction of one's self-esteem due to self-labelling as the one that is socially unacceptable (Corrigan, 2004).It can decrease the tendency of one's will seek services even though they realise the consequences (e.g., increased suffering) of not seeking counselling are severe (Sibicky & Dovidio, 1986).Kessler et al. (2007) reported that one in four people who need help did not seek services due to the concerns about what others might think.On the other hand, public stigma is the perception held by a group or society that is socially unacceptable such as discrimination, stereotyping and prejudice (Corrigan, 2004).Therefore, people are trying to hide their psychological concerns and avoid treatment in order to minimize the harmful consequences associated with the public stigma (Corrigan & Matthews, 2003).Past studies have found that, public stigma related to mental health issues have been associated with negative help-seeking attitudes (Shea & Yeh, 2008;Vogel, Wade, & Hackler, 2007).
Looking into the barriers of intention towards help-seeking behaviour, Morgan and Robinson (2003) have found that Asian students are more willing to seek help from informal sources, such as family and friends because of their culture.Later, Salim (2010) reaffirmed that Asian culture, having negative correlation towards help-seeking with any counselling services even they are facing any problems.In fact, Asian students feel uncomfortable to seek help from a stranger.During one to one counselling meeting, students need to share all their information in a structured place and time.In fact, this makes students afraid towards counselling services (Alavi, Shafeq, Geramian, & Ninggal, 2014).
The individual perceived help seeking from another is often internalized by the individual as meaning they are inferior or inadequate Vogel, Wade, and Haake (2006).Therefore, a person may decide not to seek help even when they are experiencing problems.In addition, individual belief that it would be a sign of weakness or an acknowledgement of failure by others if they go for counselling services.Generally, social problems and personal difficulties arise when students enrol in a new university and this may generate psychological distress such as low self-esteem (Lee, Olson, Locke, Michelson, & Odes, 2009).
Self-esteem could be another barrier towards help-seeking behaviour.The individual who is surrounded by mental illness are related to low self-esteem and eventually they prefer not to seek help from any professional or non-professional (Vogel, Wade, & Hackler, 2007).The students with high self-esteem tend to seek help from counselling services, whereas those students with low self-esteem are less willing to do so (Cepeda-Benito & Short, 1998).
Race is defined as a biological characteristic of individuality which is reflected in their physical appearance.Besides that, the race is also known as a social construction that maintains a socio-political (Helms, Jernigan & Mascher, 2005).Consistent with the above statement, Omi (2001) argued that, race is defined as differences in hair texture, skin colour and other physical attributes, often perceived as surface manifestations of deeper, underlying diffidence in intelligence, temperament, physical prowess, and also sexuality.In terms of culture, counselling has long used the terms of race.Non-Western (Asian, African), such as Chinese or Japanese having less positive attitude; meanwhile westerner (European & Latin) having positive attitudes towards seeking help from counselling services (Oliver, Reed, Katz, & Haugh, 1999).Later, Atkinson (2007) reaffirmed that Chinese national group endorsing less positive attitudes, while national group having positive attitudes toward seeking help from any counselling centre.Asian culture is more preferable to seek the assistance from the same racial background as theirs (Morgan & Robinson, 2003).Moreover, Asian students perceived that counselling system is racist and biased, which lead to less positive attitude towards seeking help from counselling centre.Counsellors should be aware of racial factor, which can underutilize usage of counselling services.Meanwhile, European America values having positive correlation toward help seeking with counselling services when there is a problem occurs.The influence of racial values on help-seeking behaviour is important they have a close relationship with counsellors (Nina, 2009).
A young adolescent who had experienced the counselling service previously have more favourable intention in seeking counselling help in future or later time (Koydemir-Özden & Erel, 2010).On the other, one study had focused on the past experience of counselling service among students has reaffirmed the results (AEgisdóttir, O'Heron, Hartong, Haynes, & Linville, 2011).The barriers of seeking help can be reduced if the past physiological help has been successful.Lee, Olson, Locke, Michelson and Odes (2009) reported that 75% out of 100% of students enrol in a university after they experience the help of counselling services and the number of students enrolled is actually increased.Students that have past experience in seeking help from counselling, has the highest retention rate compared to students who did not seek help (Lee, Olson, Locke, Michelson, & Odes, 2009).According to Vogel and Wei (2005), intention to use counselling services can be identified as desired to act or to use the counselling services in the future.Those individuals who have no previous experience in any counselling services have the highest level of avoidance in seeking help from counsellor even they know if they can benefit from it (Vogel, Wester, & Larson, 2007).Moreover, those who have sought help previously from any counselling centre will have less fear compared to those who did not seek help before.People who have high levels of satisfaction from previous counselling services are more willing to seek help (Seligman & Csikszentmihalyi, 2000) and expect to have more satisfactory help-seeking experiences in the future (Ciarrochi & Deane, 2001).On the other hand, the individual who had bad experiences in previous counselling services will eventually lead to less intention in seeking counselling services in the future (Vogel & Wei, 2005).

Materials and Method
Sampling and location: Prior to data collection, 30 university students were recruited at a private university to test the reliability of the adapted instrument.A private university in Kuala Lumpur was conveniently chosen and this study only focused on undergraduate students.In details, students were stratified by year of study and six courses were randomly selected.Then, an email request were sent to the specific lecturers for posting the online view link in Google docs and posted in the learning management system.A total of 250 sets of completed study were collected.

Variable measurement and data analysis:
The questionnaire consists of two parts, section A is relevant to student's demographic information such as gender, ethnicity, nationality, education level and years of study and section B is relevant to the selected variables that adapted from past studies.Dichotomous scale was employed to value the past experience of using the counselling service (Greenidge, 2007;Wilson, Deane, Ciarrochi, & Rickwood, 2007) and counselling service awareness (Flansburg, 2012;Hyun, Quinn, Madon, & Lustig, 2007) of undergraduate scholars.The item response is 'Yes' and 'No' with scoring of one and zero.Five-point ordinal scale was used to assess attitude towards counselling service (Salami, 1998;Greenidge, 2007;Flansburg, 2012), perceived barriers to access counselling services (Vogel, Wade, & Haake, 2006;Flansburg, 2012) and intention to use.The responses of five-point ordinal scale range from strongly agree to strongly disagree and the scoring of one to five points.And so, the summed score for each variable were calculated for analysis purposes.IBM SPSS version 22 was used to perform descriptive, normality, reliability test and hypothesis testing based on 95% confidence interval.Independent Sample T-test and correlation analysis was applied to achieve second aim and the third aim of this study.

Results and Discussion
Profile of respondents: In this study, nearly 80% of the respondents are Malaysians and the remaining are international students.The majority of the respondents are female (60.80%),Chinese (76.80%), pursuing Bachelor Degree (75.20%) and in the third year of their study (47.60%).
Reliability Test: The reliability test results were brought forth as shown in Table 1.The Cronbach's Alpha for the selected variables is ranging from 0.517 to 0.770 and the results consider as acceptable because it is more than 0.5 (Sekaran & Bougie, 2010).

Past experiences (CSE) and awareness of counselling services (AW):
Itemized analysis results were summarized in Table 2 for past experiences (CSE) and awareness of counselling services (AW), Table 3 for attitude and perceived barriers to access towards counselling services and the intention to use counselling services.More than half of the students do not have experience of counselling services before, either on-campus or off-campus 65.6% to 86.80% (CSE1 to CSE3).On the other hand, the majority of respondents (71.6%) know their university do provide free counselling services to them.Approximately 60% of the students know the location of the counselling centre, know where to go for professional help in the university and aware the availability of guidance services in their university.Despite this, only 40.4% of the students know the counselling services available in their university.The percentage that students aware of the counselling services availability is consistent with a study conducted by Yorgason, Linville, and Zitzman (2008).3 show that the students receive a confident belief that counsellors help them to see themselves realistically to take sensible decisions (55.2%).Although about half of the students perceived neutral that their troubles are none of a counsellor's business, only the portion of students disagree (30.0%) this statement is slightly higher than those agreeing (18.8%).In fact, they do not feel hesitate to see the university counsellor (38.4%) and they believe that it would be beneficial to expose their personal info to a counsellor (26.0%).
In term of perceived barriers to accessing counselling services, there are 21.6% to 28.8% of the students have a neutral perception (PB1 to PB5).In fact, the students agreed that seeking help from counselling services does not affect their self-confidence (56.4%) or self-image (58.4%).Surprisingly, 55.2% of the students would like to seek counsel from someone who is having the same ethnicity or race and seek help from someone other than a professional counsellor (66.0%).Also, they would not have fears about being misinterpreted by the counsellor (57.4%).Lastly, the students do not expect to receive counselling services in near six months (50.8%).The student perceived neutral about intention to use on-campus counselling services (ITU2) (33.6%) and they might want to have psychological counselling in the future (ITU3) (36.0%).The percentage of disagree and agree towards these two statements is almost equally distributed at about 30%.The students are intending to seek counselling services if they are facing issues of depression (53.2%) and education (56.0%) but not for the issue with their parents (43.2%).Note.SD= strongly disagree, D= disagree, N= neutral, A= agree, SA= strongly agrees.

Discussion
An independent sample T-test was conducted to compare the mean for selected variables score for Malaysian and non-Malaysian students.There was a significant mean difference in past experiences score [t (248) = -4.407,p < 0.05], awareness [t (248) = -2.664,p < 0.05] and intention to use counselling services [t (248) = -2.763,p < 0.05] in term of nationality.This indicated that non-Malaysian students were having more past experience and aware of counselling services available in their university compared to Malaysian students.Besides, non-Malaysian students have higher intentions to use counselling services in near future.Whereas, there was no significant differences in mean score of attitude [t (248) = -0.073,p > 0.05] and perceived barriers [t (248) = -0.260,p > 0.05] to accessing counselling services with the nationality.
In conditions of gender differences, findings showed that the female is less mindful about the counselling services provided in their university compare to male counterpart [t (248) = -2.066,p < 0.05].No other significant patterns have been observed for past experiences, perceived barriers to accessing counselling services and intention to use counselling services.
A one-way between-groups analysis of variation (ANOVA) was done to investigate year of study in mean score of intention to use counselling services.Preliminary assumption testing was conducted to check for normality and homogeneity of variance with no serious violations noted.The ANOVA test revealed that there was a statistically significant difference in mean score of intention to use counselling services [F (2, 248) = 3.580, p < 0.05].Bonferoni Post Hoc indicated that the year 2 students obtained a significantly lower mean score (M = 6.71,SD = 1.73) than year 1 (M = 7.44, SD = 1.63) and year 3 (M = 7.40, SD = 1.53).This stands for the freshmen (year 1) and final year students (year 3) are more loath to seek for counselling help.While, freshmen students in most of the time will be guided by their seniors.However, the reasons of why senior students have higher perceived barriers to counselling need to be explored in further studies.
The results of correlation analysis for the selected variables with the intention to use counselling services (refer Table 4.6).Results revealed that there were significant relationship between past experiences (r =0.180, p < 0.05) and awareness (r = 0.189, p < 0.05) and intention to use counselling services among the students.Therefore, those students with past experience tend to seek assistance for counselling service again.This result is consistent with a study by Vogel, Wester and Larson (2007).Those individuals who have no experience in seeking help from any counselling services before tend to avoid seeking counselling services (Vogel, Wester & Larson, 2007).If the students aware of the counselling services are provided by their university, they also tend to use the services when they need it.Hence, counselling related workshops or seminar should be conducted to create awareness and reduce the negative thoughts towards counselling services to increase intention to access counselling services.On the other hand, there is no substantial relationship between attitude (r =-0.027, p > 0.05) and perceived barriers (r =0.046, p > 0.05) to accessing counselling services and aim to use counselling services.

Conclusion
It was found that past experiences, awareness and intention to use has a significant relationship with their intention to utilise counselling services within their universities.In contrast, the attitude and perceived barriers to access is not perceived as a factor to seeking counselling.Certain similarities and difference of selected variables by gender, nationality and year of study have been explored in the discussion session.The results of this study enabled to have useful insight for the counselling centre in the university.According to Ashford and LeCroy (2009), the result obtained from only one university cannot represent the same results in other universities in Malaysia.This is due to the different environment, background and culture, causing different types of students to respond.Thus, students from another university may have different thoughts towards the counselling services provided by their university.This study only focused on one private university in Kuala Lumpur.Thus, it is not able to generalize university students as a whole.In terms of nationality distribution, there was a high percentage (80.40%) of respondents were Malaysians while non-Malaysians only contributed approximately 20%.Thus, future study should increase the ratio of non-Malaysian students in order to produce more representative results.
Future study also can expand to postgraduate students to improve their student experiences.Theory of Planned behaviour (TPB) to understand the intention to use counselling services can be used to achieve rigour, the hallmarks of scientific research.This study only focuses on the attitude and perceived barriers, but not the subjective norms.Thus, it is recommended to include subjective norm and actual usage of counselling services.
The model of intention to use should be developed based on the TPB.Knowing that, using counselling services will bring benefits to both students and university.It is also suggested that, longitudinal design is to be employed to keep track of counselling services actual usage by their students.

Table 1 .
Summary table for reliability test of selected variables

Table 2 .
Descriptive statistics of respondents for past experiences (CSE) and awareness of counselling services (AW)

, perceived barriers to accessing (PB) counselling services and intention to use counselling services (ITU):
Generally, the percentage of students select the response of neutral in attitude towards counselling services is relatively high compared to other responses.Results from Table

Table 3 .
Descriptive statistics of respondents for attitude (AT), perceived barriers to accessing (PB) counselling services and intention to use counselling services (ITU), in percentage mental health services, I believe that the people I interact with would think bad things of you.Imagine you had a problem that needed to be treated by a mental health professional.