Factors that Contribute to Attitudes Towards Professional Psychological Help Seeking for Mental Health Issues Among Teacher Trainees in Kenya

Mental illness including substance abuse disorders is a major concern among college student population, yet nearly half of them have no knowledge on mental health issues. In addition more than half of these students report not to have received any information on mental health or sought any help for a mental illness, causing a great magnitude of health burden. This study aims to determine factors that contribute to attitudes towards professional psychological help seeking for a mental illness. Four colleges out of the existing 20 public primary teacher colleges were conveniently sampled, and all present consenting students were recruited for the study. Two colleges formed the experimental group while the other two formed the experimental group. Baseline assessment using researcher developed demographic questionnaire, with three standardized tools of opinions about mental illness, attitudes towards professional help seeking and expectations about counseling were used to collect data. Psychoeducation was given to the experimental group, and three other evaluations using the same tools were done, one soon after the psychoeducation, third and fourth three and six months after the psychoeducation, The control group only received two other evaluations, soon after baseline and three months after baseline. This study found out that opinions about mental illness, expectations about counseling, psychoeducation, experience in teaching before coming to collage and being female gender contribute significantly to attitudes towards professional psychological help seeking for a mental illness. Main recommendation made is to include mental health education and counseling in teacher training curriculum to improve attitudes to seeking help.


Introduction
College students are characterized by rapid intellectual and social developments. In addition they face situations and circumstances that are a risk for mental illnesses. [1,2]. Mental illness including substance abuse disorders is a major concern among college student population, yet nearly half of them have no knowledge on mental health issues. [1,2]. In addition, more than half of these students report not to have received any information on mental health from their college or university, [1]. One out of four people globally are affected by mental health problems in some time in their livers, WHO report, [3] causing a great magnitude of health burden that does not match the size and effectiveness of response demands.
These mental health problems especially alcohol use disorders are common in collage age population [4], and are reported to be increasing significantly, placing a huge burden on health systems, the individual, the family, the college community and the society in general, [5]. Despite the above, most young people are known not to seek help globally, [6][7][8].

Young People Help Seeking Attitudes
Young people and adolescence have been reported to seek help for physical health care compared to mental health problems, [9]. Only 42.8% of young people with mental health problems seek help from a professional in the last three months among those attending primary health care clinics in the urban cities, [10].
Other studies have indicated that young people have negative attitudes towards professional psychological help seeking globally, [11][12][13][14]. Some of the reasons pointed out being negative attitudes towards seeking help for a mental illness problem, [13,15], lack of knowledge on where to seek help, [16], not being able to recognize symptoms due to poor knowledge of mental illness, [17].
Less is known about the contribution of the expectations about counseling, opinions of mental illness and socio demographic characteristics on attitudes about professional psychological help seeking for a mental illness in this region. The aim of this study is to determine factors that contribute to attitudes towards professional psychological help seeking among college students.

Importance of Factors That Contribute to Attitudes Towards Help Seeking for Youth
The prevalence of depression has been found to be high in sub-Sahara Africa, 31.4% in South Africa, [18]. Furthermore most (57%) young people between the ages of 18-29 years of age who have been identified with depression do not seek help, [18], part of the reason being lack of knowledge on these illnesses.

Overall Objective
This study aimed at determining some of the factors that contribute to attitudes towards professional psychological help seeking among college youth in Kenya.

Study Design and Sampling
This study is part of a larger longitudinal quasiexperimental study namely: "The Effects of Psychoeducation on attitudes towards mental health seeking behavior among primary school teacher trainees in Kenya".
Four primary teachers colleges were sampled conveniently from the twenty public colleges. The target population was estimated to be of an average age between 18-42 years. The sampled colleges were estimated to have a population of 3400 students both first and second years, based on Ministry of Education records (Statistics Department). It was learned that recruitment for teacher training was based on a quota system, meaning all parts of the country would be represented. All consenting and present participants were recruited for this study with the aim of increasing generezability of the results.

Ethical Considerations
The Kenyatta National Hospital and Nairobi University Ethics Committee (KNH/UON-EC) protocol, which sets forth research ethics concerning individual's personal data, was strictly adhered to, in order to ensure confidentiality. With ethical approval, authority and permission was sought from the Ministry of Education and college principals respectively. The purpose, plan and implications of the study were explained before meeting the participants.

Procedure for the Study
These participants were met at the college normal classrooms, where informed consent was sorted, and the measure tools were presented to them while sited in their normal classrooms. The dully-filled forms were sealed and placed at the front into a sealed box. The experimental groups from two colleges were given four measures one at baseline, second soon after psychoeducation, the third fourth three months and ten months after psychoeducation respectively. The control group on the other hand had only three assessments, one at baseline, the second soon after the baseline and the third, three months after baseline assessment.

Data Management
Collected data was double entered into the computer by two clerks separately, and later analyzed using SPSS Version 19.0. The GLM Univariate procedure was used to provide a regression analysis and analysis of variance for attitudes towards help seeking by the demographic factors.

Expectations About Counseling Contribution to Attitudes Towards Seeking Professional Help Seeking
This study found that an expectation about counseling is a significant (p=0.000) contributor to attitudes towards professional psychological help seeking. This means that with a more positive expectations about counseling due to a mental illness, there is likely to increase in attitudes towards professional psychological help seeking. This result is similar to other findings, [22][23]. This is further supported by a study by Scott et al, [24] who reported that males and specifically black males are not likely to seek professional help for psychological problems.

Opinions About Mental Illness Contribution to Attitudes Towards Seeking Professional Help Seeking
This study reported that opinions of mental illness significantly (p=0.000) contributed and predicted attitudes to professional help seeking among these participants. This finding is similar to findings of Wenjing, et al [25] among Australian University students. In addition, a study by Loeng & Zachar, [26] found out that opinions about mental illness was a significant contributor to attitudes towards mental illness, especially being more benevolent, higher mental hygiene, and being less socially restrictive and less authoritarian.

Psychoeducation on Mental illness and Expectations About Counseling Contribution Towards Attitudes to Seeking Help for a Mental Illness
Psychoeducation significantly (p=0.000) contributed and predicted attitudes towards professional help seeking among this participants. This is similar to other studies, among college students [27], and the community, [28][29][30].

Previous Teaching Experience Contribution to Attitudes Towards Seeking Professional Help
Previous teaching experience before coming to college indicated a significant (P=0.000) contribution towards help seeking among these participants. This is in line with other studies, [31].

Gender Contribution on Attitudes Towards Seeking Professional Help Seeking
Being of the female gender contributes significantly (p=0.000) to favourable attitudes towards professional psychological help seeking among these participants. This is similar to other studies globally among college students and others, [22][23]31]; although Watson 2014 [32] did not find any significant contribution in gender among young people in Australia.

Conclusion and Recommendations
This study concludes that opinions about mental illness, expectations about counseling, psychoeducation on mental health and expectations about counseling for a mental illness, previous teaching before coming to college and being of the female gender contribute significantly on attitudes towards professional psychological help seeking for a mental illness among these participants.
The implication is that for college students to improve attitudes towards help seeking, they should get knowledge on mental illness and expectations about counseling for a mental illness. Knowledge on mental illness would be able to make them not only identify the signs and symptoms of mental illness amongst themselves, but among peers and students they are expected to teach in their formal teaching in schools. Knowledge would also make them disminify the cultural beliefs of causes, treatment and course of mental illness in the community. Literacy in treatment of mental illness would make them learn to visit psychologists when signs and symptoms arise or refer others for the same. When they know what to expect in counseling it will go a long way to assist in attitude change and seek help. The male gender, may need more than the female gender in changing attitudes for help seeking.
The study recommends the following: 1) The college students should be able to learn that mental illness is rampant at college and should be able to identify signs and symptoms not only in selves but among peers and the students they are going to teach to seek help early.
2) The policy makers, that is the government should increase psychologists in colleges to improve identify mental illnesses, give psychoeducation to improve mental health among the students.

3) The policy implementers, the administration and lecturers
should improve the college curriculum by including mental health literacy and counseling classes so that the students will be armed with knowledge to identify mental illness among selves, their peers, and the school community. 4) Other researchers should continue researching on other barriers to professional psychological help seeking for a mental illness in this region, so that we can be able to improve attitudes towards help seeking specifically among the youth.