Health Education and Health Promotion

Enhancing Mental Health Literacy in University; Interactions between Student Initiatives and Counselor Strategies

Document Type : Qualitative Research

Authors

E.N. Wahyuni 1
R. Mangestuti 2
I.T. Rahayu 2
R. Aziz 2
A. Muhid 3

1 Department of Islamic Education, Faculty of Tarbiyah and Teaching Training, Maulana Malik Ibrahim Islamic State University Malang, Kota Malang, Indonesia

2 Department of Psychology, Faculty of Psychology, Maulana Malik Ibrahim Islamic State University Malang, Kota Malang, Indonesia

3 Department of Psychology, Faculty of Psychology, Sunan Ampel State Islamic University, Surabaya, Indonesia

https://doi.org/10.58209/hehp.12.2.215
Abstract
Aims: Previous mental health research has often treated counselors and students as distinct entities, resulting in a lack of comprehension and knowledge at the university level. This study aimed to investigate efforts to enhance mental health literacy in university settings by examining the interaction between student initiatives and counselor strategies.

Participants & Methods: An exploratory qualitative methodology was employed, utilizing interviews, observations, documentation, and focus group discussions as data collection tools. The participants were chosen using a purposive sampling technique based on specific criteria.

Findings: The findings revealed three categories of student initiatives (self-initiative, peer-initiative, and collaborative initiative) and various counselor strategies (education and information, counseling and mentoring, and collaboration with stakeholders). The synergy between these two entities forms an educational and collaborative interaction pattern that fosters mental health advancement.

Conclusion: There are three practical measures to enhance students’ comprehension and awareness of mental health, including prioritizing mental health in new student orientation programs, creating collaborative mental health initiatives, and encouraging student engagement in developing mental health programs within the university environment.

Keywords

Mental health
Education
Students
Empowerment
Subjects
Introduction
The low level of mental health literacy among college students raises significant concerns about the well-being of young individuals. The main factors contributing to this low literacy level are believed to be stigma, limited access to resources, and inadequate understanding of symptoms associated with mental health issues [1, 2]. Furthermore, insufficient literacy skills can lead to the disregard of counselors’ and students’ perspectives in efforts to enhance mental health literacy [3, 4]. The World Health Organization (WHO) surveyed 19 universities in eight countries, revealing that 31% of students were diagnosed with mental disorders, and 35% reported thoughts, plans, or attempts of suicide [5]. A recent study indicated that approximately 20% of students in Southeast Asia experience anxiety, stress, and depression, and show increased suicide rates [6]. The incidence of student suicides in Indonesia is increasing, with at least five reported cases in 2023 [7, 8]. Inadequate knowledge about mental health among students may have led to missed opportunities to prevent severe depression and suicide cases [9, 10]. Therefore, the primary barriers that need to be addressed are the stigma and misconceptions surrounding the responsibilities of counselors, as well as the lack of collaboration in developing mental health education initiatives.
A review of previous studies reveals three trends in students’ mental health literacy. The first area of investigation involves examining various student literacy profiles and their efforts to seek help for mental health issues [11, 12]. Meanwhile, recent scholars have focused on evaluating the effectiveness of different counseling approaches and interventions as remedial actions to enhance students’ mental health literacy [9, 13, 14]. Additionally, another research focus has been on developing reliable tools to assess students’ mental health literacy, aiming to gauge their knowledge and skills related to mental health [15-17]. These three research trends indicate that the interactions between students’ initiatives and counselors’ strategies have not been extensively explored in the context of student mental health literacy.
The foundation of this research lies in the belief that the interaction between student initiative and counselor strategies plays a crucial role in effectively enhancing student mental health literacy. Students who proactively seek to comprehend mental health are inclined to enhance their mental health literacy with the support and guidance of counselors. Moreover, counselor strategies that are targeted and flexible to meet students’ mental health literacy requirements will have a positive influence on students’ understanding and abilities related to mental health, thereby instilling confidence in managing their mental health issues. Hence, the selected methodology will examine this premise and address the research objectives.
This study aimed to address the gap in previous research, which has not thoroughly examined the relationship between student initiatives and counselor strategies to enhance student mental health literacy in higher education settings. Aligned with this objective, three specific goals, including identifying how student initiatives enhance mental health literacy, identifying counselor strategies to improve student mental health literacy, and establishing patterns of interaction between student initiatives and counselor strategies to enhance student mental health literacy were outlined. These three specified objectives are anticipated to offer a comprehensive insight into how students engage in seeking, acquiring, and utilizing mental health resources, as well as how counselor strategies can cater to students’ mental health literacy requirements.

Participants and Methods
Settings and design
This qualitative exploratory research was carried out on students and counselors at the three leading Islamic state universities in Indonesia, which fall under the jurisdiction of the Indonesian Ministry of Religious Affairs in 2023. All three universities have a team of counselors who offer guidance and counseling services to their students. Interviews conducted with counselors at these universities revealed that the advancement of mental health literacy is not optimal due to various barriers and challenges, including policy, resource, and stigma-related issues. It is worth noting that despite the less-than-optimal conditions for enhancing mental health literacy, there are students enrolled at these universities who have taken steps to enhance mental health literacy within the academic setting. This intriguing observation has piqued the researchers’ interest in exploring the relationship between students’ initiatives and counselors’ strategies for improving students’ mental health literacy.
The qualitative exploratory research design was used to delve deeply into the experiential phenomena of research participants, aiming to achieve a comprehensive understanding of the subject under study. Additionally, qualitative research design allows for a limited number of participants, as the emphasis is on the depth of the collected information or data. Therefore, the qualitative research design was in line with our research objectives of thoroughly examining efforts to improve mental health literacy in universities, with a specific focus on the perspectives of students and counselors, while utilizing a constrained sample size selected by purposive sampling.
Participants
The participants were students (coded as I-S) and counselors (coded as I-C) from the three designated universities selected by a purposive sampling technique based on inclusion criteria, including active involvement in mental health activities, experience with counseling services, understanding of mental health development in higher education, and willingness to share experiences and concerns regarding mental health in higher education. Eight students took part in the study, consisting of six undergraduate students and two graduate students. Additionally, six of the participants were professional counselors who also held teaching positions. This dual role enabled them to promote mental health literacy among students. Purposive sampling was employed to ensure that the collected data aligned with the research objectives.
Data collection
The data were collected through interviews, observations, and documentation techniques. By utilizing open interview methods, the researchers delved deeply into the perspectives and personal experiences of respondents regarding mental health literacy. Interviews were conducted using WhatsApp voice notes, chats, and calls. Examples of open-ended questions posed to student respondents during the interviews included: “Have you ever encountered mental health issues? If yes, could you elaborate on that experience?”; “What motivates you to show concern for the psychological challenges faced by others?”; “How do you actively engage in mental health awareness activities or communities on campus?”; “Can you describe how campus counselors respond to mental health initiatives and discuss the factors that facilitate or hinder their response?” Additionally, counselors were asked questions such as “How do you utilize techniques to enhance students’ comprehension of mental health?” and “What strategies do you employ to support and empower students in becoming advocates for promoting mental health awareness?” The researchers also conducted observations to gather data on the activities of both students and counselors. Observations were carried out through direct and indirect means using video recording technology. The collected documents included photos, electronic files, videos, social media posts, and website content. These three techniques were used interchangeably to triangulate the data.
Data analysis
The qualitative data analysis was carried out in four structured steps. Initially, data from interviews, observations, and documentation were meticulously reviewed, and specific thematic patterns were identified, distinguishing between elements of student literacy initiation and counselor strategies for fostering mental health awareness. Subsequently, a thorough analysis was conducted to pinpoint nuances and key concepts that surfaced from the respondents’ accounts. Then, major themes were systematically arranged to investigate relationships and patterns of interaction. Lastly, by employing convergence and divergence approaches, student and counselor viewpoints were scrutinized to gain a deeper insight into how interactions between student initiation and counselor strategies influence each other in enhancing mental health literacy on campus. These two methodologies offer a more comprehensive and profound perspective on the phenomenon being studied. These four steps of data analysis contribute to a comprehensive understanding of the factors influencing student mental health literacy and facilitate the formulation of more effective intervention recommendations.

Findings
The study included students and counsellors at the three leading Islamic state universities in Indonesia (Tables 1 and 2).

Table 1. Demographic characteristics of counselors


Table 2. Demographic characteristics of students


The gathered data were analyzed and categorized into three sub-themes, including student initiatives, counselor strategies, and the correlation between counselor strategies and student initiatives in enhancing mental health literacy.
Students initiating to development of mental health literacy
In the context of mental health literacy, student initiation involves the active engagement of students in initiating or participating in activities to enhance their understanding, knowledge, and skills related to mental health. This study categorized student initiation into three groups: self-initiated, peer-initiated, and collaborative-initiated (Table 3).

Table 3. Student initiation to enhance mental health literacy


The first category, self-initiated, refers to students’ independent efforts to gain knowledge about mental health. All student participants mentioned that their awareness of self-initiation stemmed from the mental health difficulties they encountered. Their personal struggles with mental health concerns inspired them to seek comprehensive information about their issues and effective coping strategies. For instance, I-S1 shared her experiences with mental health challenges and how she sought information to manage them.
“...I once experienced depression that made me unhappy, insecure, and uncomfortable interacting with others. My academic performance was low and my physical condition was unhealthy. Fortunately, I had the spirit to overcome these psychological problems by reading books on stress management, consulting campus counselors, and engaging in activities that produced immediate results...” (I-S1)
Aligned with I-S1, I-S4 also encountered a lack of self-confidence that resulted in feelings of inadequacy, social discomfort, and negative self-talk. These emotions led to isolation and discontent. Seeking assistance from her academic advisor and faculty counselor, she actively gathered information to address these challenges and observed her peers grappling with mental health issues. Through this journey, I-S4 enhanced her self-awareness and acquired skills to manage mental health concerns. In essence, students’ self-initiation can evolve from their encounters with mental health difficulties.
Peer initiation represented another form of student engagement in sharing mental health knowledge with others (Table 3). In practice, peer initiation manifests in various ways, including a willingness to exchange information, openness about mental health struggles, accompanying friends to seek guidance from counselors, and participating in student mental health advocacy groups. I-S3, one of the student participants, said:
“…having mental health issues experience has made me more empathetic towards friends who are going through similar struggles. I am willing to provide listening, offer support during tough times, and assist in finding resources such as on-campus counseling services…” (I-S3)
The study revealed that student peer initiatives can be actualized through the utilization of digital media as a platform for information and education to enhance student mental health literacy and peer counseling. The third form of collaboration-initiation referred to students’ proactive engagement in enhancing their comprehension of mental health through collaboration with campus counselors and mental health organizations off-campus, as articulated by one of the participants, I-S5:
"In fact, joining a mental health community will not only increase our understanding of mental health but also network with other activists who are concerned with improving mental health literacy on campus.
Webinar activities conducted in partnership with college counselors and mental health training sessions were among the various forms of student-initiated collaboration.
Consequently, student self-initiation served as the catalyst for the emergence of peer-initiated and collaborative-initiated actions. Student self-initiation had a significant impact on enhancing the mental health literacy of individual participants, their peers, and stakeholders involved in mental health advancement.
Strategies by counselors to enhance students’ mental health literacy
Counselor strategies aimed at enhancing students’ mental health literacy involve counselors’ endeavors to boost students’ comprehension, awareness, and skills concerning their mental well-being and that of those in their surroundings. The study identified at least three types of counselor strategies for improving students’ mental health literacy (Table 4).

Table 4. Counselors’ strategies to improve student mental health literacy


One counselor strategy involves providing information and education on mental health, symptoms of mental disorders, and methods to address them. This approach is executed through various channels, including informal classroom discussions, counselor-led lectures during new student orientation programs, seminars, counseling sessions, and awareness campaigns. Insights from interviews with multiple advisors (I-C1, I-C3, and I-C6) validated that they imparted mental health information and education to students through lectures, seminars, and orientation sessions for new students. As per the participants, these strategies had both preventive and remedial impacts on students’ mental health issues.
Table 4 outlines counseling and mentoring as remedial strategies to assist students in comprehending their issues and cultivating practical skills for managing mental health. Counseling services have proven effective in enhancing students’ mental health awareness and skills, as indicated by the findings from interviews with counselor participants. For instance, one informant (I-C5) stated:
"...consultation and counseling services both individual and group are very effective to provide education on understanding and self-awareness of problems and effective problem solving to overcome them..." (I-C5)
In addition to counseling, counselors employ mentoring strategies following the conclusion of the counseling process. According to informants (I-C4), the mentoring approach efficiently monitored post-counseling progress and encouraged students to sustain mental well-being while reducing stigma.
The collaborative strategy represents the third approach, involving efforts to boost students’ mental health literacy through collaboration with various stakeholders, including the students themselves. Interviews with counselor informants (I-C4, I-C7, and I-C8) unveiled that engaging in collaboration with students enabled counselors to effectively reach a broader student audience, thereby enhancing their mental health literacy. Collaborating with students also addressed constraints encountered by counseling center staff.
“…collaborating with students is beneficial in addressing the shortage of counselors for improving mental health education. Students who are interested in becoming mental health volunteers will receive training as peer counselors...” (I-C6)
By integrating all three strategies, counselors can establish a comprehensive approach to aid students in overcoming challenges and laying a robust foundation for academic and personal success.
Interacting student initiation and counseling strategies
Within the realm of mental health literacy at universities, the dynamic interplay between student initiative and counselor strategies creates a reciprocal relationship that influences each other. Students serve as the recipients, while counselors act as knowledgeable professionals in the mental health field. This study identified three types of connections (educational, collaborative, and empowering) (Figure 1).


Figure 1. Interaction of student initiation and counselor strategies

The primary interaction observed was the educational interaction, which entailed educating, understanding, and raising awareness about mental health (indicated by red arrow lines). This educational interaction occurred when counselors utilized strategies to educate students on mental health issues. The counselor’s strategies were tailored to meet students’ requirements for acquiring comprehensive mental health knowledge and information. This educational interaction took place during counseling and mentoring sessions, activities within lecture classes, training sessions, and seminars. An informant (I-C5) emphasized the need for continuous efforts to enhance mental health literacy in students through diverse methods, ranging from providing information and counseling sessions to training and seminars.
"…My counselor motivated me to learn from different sources and attend seminars, and self-development trainings to gain insight into mental health. It's made me want to help my friends who are having mental health problems..." (I-S1)
The second interaction, collaborative interaction, denotes the partnership between students and counselors in enhancing mental health literacy within the campus environment (illustrated by a green dotted line in Figure 1). This interaction was cultivated through activities such as organizing seminars, and training sessions, offering support, peer counseling, and mentoring. Collaborative interaction can establish an atmosphere where both parties play pivotal roles in cultivating a mental health-friendly climate on campus. As per counselor informants (I-C2, I-C5, and I-C6), collaborating with students addressed the challenge of limited counselor resources for implementing mental health service programs on campus. Concurrently, insights from student informants (I-S4, I-S5, I-S7, and I-S8) indicated that the collaboration between students and counselors in mental health initiatives positively impacted the enhancement of their knowledge and awareness of mental health. Active engagement in such endeavors can provide avenues for learning and mutual support, fostering an environment that nurtures a deeper comprehension of mental health among students.
Thirdly, the empowerment interaction represented a mutually empowering dynamic between students and counselors in enhancing mental health literacy. Figure 5 illustrates a blue dotted line surrounding the interaction of student initiative and counselor strategy. One counselor (I-C3) emphasized that all strategies employed by counselors to enhance mental health on campus aimed at empowering students to act as literacy advocates for themselves and their peers. Findings from interviews with counselor informants indicated that all types of strategies utilized by counselors had a significant impact on fostering feelings of empowerment to enhance mental health literacy on campus.
"…We appreciate students' experiences and involvement in mental health literacy on campus. We position students as agents of mental health literacy for themselves and other students. We have different ways to help them deal with mental health issues…” (I-C3)
“I feel better when I help my friends with their mental problems. My knowledge grows when I do mental health activities. Especially when the counselor allows me to be a peer counselor for other students..." (I-S5)
Accordingly, any student-initiated interaction with counselor strategies, whether educational or collaborative, leads to mutually empowering exchanges. These interactions instill confidence, inspire positive transformations, and bolster mental well-being in students, while for counselors, empowerment fosters hope for cultivating a mental health-supportive environment in higher education.

Discussion
This study emphasized the dynamic interplay between student initiatives and counselor strategies in enhancing mental health literacy within a university environment. Student initiatives manifested in three forms, namely self-initiated for personal mental health understanding, peer-initiated to assist fellow students, and collaborative-initiated to collaborate with counselors and other entities. On the other hand, counselor strategies encompassed education and information dissemination, counseling and mentorship, and fostering student collaboration. The synergy between student initiatives and counselor strategies led to the emergence of three educative, collaborative, and empowering patterns. The results suggest that the enhancement of mental health literacy necessitated a comprehensive understanding from both student and counselor perspectives, as they complement each other in the process.
The study findings hold significant importance within the context of mental health literacy. The dynamic interaction between student initiation and counselor strategies had a positive impact on mental health literacy. The approach involving students initiating information-seeking behaviors, collaborating with peers, and receiving support from counselors indicate that this comprehensive framework is effective in enhancing mental health understanding and awareness [18]. Furthermore, the results emphasized the vital role of counselors in offering guidance, technical assistance, and ongoing mentorship to students. These findings underscored the importance of adopting a collaborative approach to mental health services on campus, thereby making a valuable contribution to the advancement of mental health practices and policy enhancements within the university setting.
In the realm of mental health literacy theory, the interaction between student initiation and counselor strategies plays a pivotal role in shaping the comprehension and management of mental health issues in higher education [19]. Throughout the initiation process, counselors assume a critical role in offering psychological support to students grappling with academic and social pressures [20, 21]. It is imperative for counselors to employ suitable strategies, such as furnishing information on mental health maintenance, recognizing symptoms of issues, and providing resources for stress management [22]. Student initiation fosters student engagement and introduces a fresh perspective on mental health within the campus setting. These interactions enhance students’ mental health understanding and literacy, acquaint them with available counseling resources, and ensure a consistent and comprehensive flow of information [23]. Conversely, counselors can leverage student initiation as an informal avenue to reach a wider audience and raise awareness regarding the significance of mental health care. Through these interactions, a connection is established between preventive measures and formal support, culminating in the creation of a holistic and integrated mental health environment on campus.
From a social cognitive perspective, the dynamic interaction between student initiation and counselor strategies represents a process wherein individuals learn and evolve through observation, imitation, and reinforcement [24, 25]. Consequently, when college students take the initiative to enhance their mental health, they are actively engaging in a process of self-regulation and actively seeking methods to enhance their overall well-being [26]. Counselors play a crucial role in this dynamic process, as they can empower students to cultivate practical coping skills and mental health self-management strategies through diverse approaches, including psychoeducation, consultation, and collaboration [27, 28]. When fostering mental health literacy in higher education, a comprehensive approach through student-counselor interactions is not only educational but also collaborative and empowering [29, 30]. This social cognitive approach underscores the reciprocal influence of student initiation and counselor strategies in advancing mental health development on campus.
The findings of this study align with existing research. Several prior studies, including those conducted by Mantzios [31], Yang et al. [32], Singh et al. [33], and Sui & Leng [34], emphasize the importance of promoting collaborative approaches among counselors and students, as well as among students themselves, in fostering mental well-being within the college environment. These three investigations are in agreement with the results of the current study, which support the idea that the collaborative interaction between student initiative and counselor strategies significantly contributes to enhancing student understanding and awareness of mental health. Through this comparison, our study provides an additional contribution to the field, offering further insights into the contextual factors that influence the effectiveness of mental health literacy interventions.
This study offers a comprehensive understanding of the interaction between student initiation and counselor strategies in cultivating mental health literacy in higher education. The findings lay the groundwork for three action plans aimed at enhancing mental health literacy. Firstly, it is recommended to bolster the student orientation program by incorporating specialized sessions that offer detailed information about mental health resources available on campus. Secondly, there is a need to establish collaborative initiatives involving students and counselors, such as workshops or seminars, to exchange experiences and enhance students’ mental health literacy skills. This initiative can be integrated into the counseling curriculum or co-curricular activities. Thirdly, it is crucial to support student-led initiatives to create support groups or organize awareness campaigns and mental health literacy activities on campus by facilitating infrastructure and providing resources, incentives, and guidelines. These three steps can foster a campus environment that promotes student mental health, encouraging comprehensive engagement among students, peers, and counselors.
By utilizing the interaction perspective of student initiation and counselor strategies, this study sheds light on students’ proactive endeavors in developing mental health literacy. This approach facilitated a deeper comprehension of the motivations, obstacles, and challenges they encountered during this process. Furthermore, the counselor strategies perspective enriched the research by providing insights into the professional responsibilities of counselors and identifying best practices to enhance their support role in promoting mental health among college students.
Despite limitations in the number of participants and the focus on specific colleges, this study contributes to the understanding of mental health literacy in the college setting. The researcher recommends that future studies involve a broader range of colleges with diverse characteristics and increased involvement from students and counselors to attain a more comprehensive understanding of their interactions. This inclusive approach is anticipated to spark innovative ideas for advancing mental health literacy at the higher education level.

Conclusion
Active collaboration between students and counselors yields a significant positive impact, not only as a means of transforming mental health knowledge but also in fostering a sense of empowerment to overcome mental health challenges. This positive impact plays a crucial role in preventive and remedial efforts to address issues and enhance mental health literacy among students.

Acknowledgments: The authors would like to express my deep gratitude to the leadership of Maulana Malik Ibrahim Malang Institute of Research and Social Services of Islamic State University for giving the opportunity to conduct this research. The support and resources provided by the institute have been effective in the successful implementation and completion of this study.
Ethical Permissions: This research has received ethical approval and complies with the research ethics guidelines of Maulana Malik Ibrahim Malang State University. All the steps carried out in this research have been reviewed and approved by the research ethics committee of the university.
Conflicts of Interests: The authors declared no conflicts of interests.
Authors’ Contribution: Wahyuni EN (First Author), Introduction Writer/Methodologist/Main Researcher/Discussion Writer (35%); Mangestuti R (Second Author), Introduction Writer/Methodologist/Assistant Researcher/Discussion Writer (20%); Rahayu IT (Third Author), Introduction Writer/Methodologist/Assistant Researcher/Discussion Writer (15%); Aziz R (Fourth Author), Introduction Writer/Methodologist/Assistant Researcher/Discussion Writer/Statistical Analyst (15%); Muhid A (Fifth Author), Introduction Writer/Assistant Researcher/Discussion Writer/Statistical Analyst (15%)
Funding/Support: This research was funded by the General Directorate of Islamic Higher Education of the Ministry of Religious Affairs of the Republic of Indonesia in 2023.
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Health Education and Health Promotion
Volume 12, Issue 2
Spring 2024
Pages 215-223