It may be helpful, but not for me: A qualitative study of the perceived affordances of a mental health education and counseling center among students at a key university in China

It may be helpful, but not for me: A qualitative study of the perceived affordances of a mental health education and counseling center among students at a key university in China | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article It may be helpful, but not for me: A qualitative study of the perceived affordances of a mental health education and counseling center among students at a key university in China Xiaofang Jin, Furong Lian This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8648425/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Background The students from key universities face a higher risk of depression and anxiety than those from non-key universities. However, the utilization rate of on-campus counseling services remains very low. Working from the theory of perceived affordances, this study investigates the reasons why some college students with emotional distress at a Chinese key university avoid using the provided on-campus psychological counseling services. Methods This study employed Braun and Clarke's reflexive thematic analysis method to code and extract themes from the texts obtained through in-depth interviews. It was conducted at a key Chinese university, where 13 participants were recruited using purposive sampling and took part in interviews lasting between 30 minutes and two hours. Results The study revealed that perceived affordances of the campus mental health education and counseling center (MHECC) among this group of college students exhibited three characteristics: surveillant services, counseling without empathy, and cautious peer support. Conclusions Although these negative perceived affordances of the MHECC may be inconsistent with its real affordances, they led this group of college students to make a decision to refuse help-seeking without accessing the counseling services. To enhance the usability of the MHECC, the perceived information regarding the Center’s affordances should be optimized based on college students’ experiences and cultural backgrounds. Perceived affordance MHECC Key university China Qualitative 1. Introduction Universities’ efforts at health education crucially depend on understanding their students’ mental health problems and coping strategies. The presence of mental health problems during the college years causes problems such as lower academic achievement [ 1 ], and higher dropout rates [ 1 , 2 ], thereby undermining the effective development of human capital. The college years are also a peak period for the first onset of a range of mental disorders [ 3 ]. Approximately three-quarters of cases of lifelong mental disorders first appear by the age of 24 [ 4 ]. If not taken seriously and addressed proactively, mental disorders can lead to a series of serious consequences such as poor quality of life, social isolation, and even suicide [ 5 ]. Even so, most college students with mental disorders do not receive treatment [ 6 ]. The Blue Book of The Report on the Development of National Mental Health in China ( 2023–2024 ), jointly released by the Institute of Psychology of the Chinese Academy of Sciences and China Social Sciences Press, indicates that in the past year, even though 80% of college students are aware that their schools provide free counseling services, only 2.8% have actually used such services. Even among those at high risk for depression, who have a stronger potential need for counseling, the utilization rate is a mere 9.3%. The Survey Report on the Mental Health Status of Chinese College Students in 2022 emphasizes that students from key universities, which are designated and preferentially supported by the state for their outstanding academic performance, face a higher risk of depression and anxiety than those from non-key universities. Consequently, the counseling needs of key university students and their utilization of mental health services deserve greater attention. In April 2023, the Ministry of Education of the People’s Republic of China, together with 17 relevant departments, jointly issued the Special Action Plan for Comprehensively Strengthening and Improving Students’ Mental Health Work in the New Era (2023–2025) . This plan points out that the rapid development of China’s economy and society, accompanied by constant changes in the environment for students’ growth, means that students’ mental health problems have become more prominent. For this reason, under the guidance of the educational philosophy of “Health First”, it is necessary to comprehensively strengthen and improve students’ mental well-being in the new era. Against this backdrop, there is an imperative need to gain an in-depth understanding of why there is an imbalance between the demand for on-campus counseling and its use by students at key universities, so as to increase counseling service utilization rate and expanding the group of beneficiaries. 2. Previous Research 2.1 Low willingness of college students to receive mental health services Higher education provides an ideal environment for addressing college students’ mental health problems [ 7 ]. The college campus environment typically offers rich, diverse, and interconnected resources that can exert a positive impact on students’ mental health during their college years and beyond. However, the proportion of college students with common mental disorders who actually receive professional treatment remains very small [ 3 ]. In one study, only a quarter of college students stated that they would definitely seek treatment if they experienced emotional problems [ 8 ]. Another found that two-thirds of college students facing mental health problems did not seek any treatment in the past year [ 9 ]. A survey specifically targeting postgraduate students found that the utilization rate of mental health services in that group was far lower than the apparent demand [ 10 ]. One reason for this low utilization rate is college students’ greater willingness to seek help from informal social networks than from formal mental health services [ 11 ]. 2.2 Barriers to college students seeking mental health services 2.2.1 Structural barriers and attitudinal barriers College students who have not received mental health treatment face barriers such as believing that their problems will improve on their own, questioning the severity of their own problems, a lack of time for seeking treatment, perceived stigma, and attempting to solve the problems by themselves [ 6 ]. Of the barriers they face, factors such as cost, expected time investment, transportation, and scheduling are structural barriers, while tendencies to handle problems on one’s own, preference to talk to friends or relatives, and feelings of excessive awkwardness are attitudinal barriers [ 8 ]. In countries where resources are limited, the primary means to reduce the gap in mental health services is to eliminate structural barriers by improving the availability and accessibility of services [ 12 ]. Even in countries with relatively sufficient treatment resources, the increasing incidence of mental disorders means that resources must still be expanded or reallocated to reduce the proportion of untreated students [ 3 ]. However, for college students who need mental health treatment but have not received it, attitudinal barriers are more common than structural ones [ 8 ]. Stigma, embarrassment, lack of mental health knowledge, and a preference for self-reliance are the most significant attitudinal barriers for young people seeking help [ 13 ]. Whether or not they seek help when faced with emotional problems in the future depends more on attitudinal barriers than on structural barriers [ 8 , 14 ]. College students will not use mental health services if they do not believe that psychiatrists have received professional training and consider the quality of the provided services to be poor [ 11 ]. Therefore, the reason why more students who need treatment do not receive it is not the lack of treatment opportunities, but is instead their perception that campus mental health resources have little value [ 15 ]. If they perceive the staff of the campus mental health centers as being unfriendly or untrustworthy, they will be especially deterred from seeking help [ 16 ]. 2.2.2 Low perceived need In addition to the aforementioned structural barriers and attitudinal barriers, another reason why young people do not seek professional psychological help is that their perceived need is low [ 12 ]. Among college students, a low perception of the need for help is known to directly affect their actual help-seeking behavior [ 9 ]. Many college students do not seek treatment because they perceive mental health problems as being common reactions to the stress of university life [ 6 ], or if they believe they can handle their psychological distress on their own [ 17 ], or if alternative options are available that they perceive as being less stigmatizing [ 11 ]. Low perceived need and the desire to handle problems on one’s own are recognized to be significant barriers that lead students to consider either delaying help-seeking or not seeking help at all [ 18 ]. 2.3 Perceived affordance as a form of theoretical support The concept of “affordance” was first proposed by the American ecological psychologist J. J. Gibson in his book The Ecological Approach to Visual Perception , first published in 1979. He defined affordances as follows: “the affordances of the environment are what it offers the animal, what it provides or furnishes, either for good or ill” [ 19 ]. An affordance reflects the interrelationship and interaction between the environment and the actor, and the concept of affordance is used to explain the possibilities of engaging in different behaviors in a given environment. Although the manifestation of an affordance relies heavily on the actor’s perception, an affordance still exists even when it is not perceived [ 20 ]. Norman offered a different view on this, arguing that “an affordance is a relationship between the properties of an object and the capabilities of the agent that determine just how the object could possibly be used” [ 21 ]. Since an affordance determines the possible ways in which an object can be used, it must be perceivable if it is to be relevant to the effective prediction of actions. However, poor design prevents an affordance from being directly perceived, and an affordance that cannot be perceived is of no use [ 22 , 23 ]. Thus, in terms of affordances, the actor’s perception of a thing is more important than the characteristics of the thing itself. The perceived affordances, which “result from the mental interpretation of things, based on our past knowledge and experience applied to our perception of the things about us” [ 22 ], determine the usability of things [ 24 ]. Therefore, based on usability, the perceived affordances proposed by Norman are tightly coupled with the actor’s past experience, knowledge, and culture. This differs from the Gibsonian definition of affordances, which is “independent of the actor’s experience, knowledge, culture, or ability to perceive” [ 25 ]. Norman considers an affordance to be highly interpretive, and how one interprets the purpose of a thing is directly related to the actor’s position [ 26 ]. In other words, “the interpretation of a perceived affordance is a cultural convention” [ 21 ], which may lead to an inconsistency between the perceived affordances of a thing and its real affordances [ 24 , 21 ]. Using the analytical tool of perceived affordances, what we are interested in is the following paradox: Mental Health Education and Counseling Centers (MHECCs) are widely established at Chinese universities, especially key universities, which provide free and continuously optimized psychological counseling services to meet the diverse needs of students [ 27 ]. Moreover, students in these universities have weaker perceived stigma toward psychological counseling [ 28 ]. Nevertheless, why is the utilization rate of counseling centers still low among some students with actual needs? What affordances do students at key universities perceive in their interactions with MHECCs, and how do their past knowledge, experiences, and cultural background influence this perception? This study takes a closer look at these perceived affordances in order to reveal the fundamental causes of the low utilization rates of MHECCs. Note that this phenomenon has not been satisfactorily explained by previous one-sided analyses, which have focused on structural barriers, attitudinal barriers, and low perceived need. 3. Methods 3.1 Ethics and study design This study was approved by the Institutional Ethics Committee of the Clinical Study of the First Hospital of Lanzhou University (Ethics Approval Number: LDYYLL2024-311). It was conducted at a key university, the MHECC of which was established in the 1980s; it is one of the first institutions of higher education in China to implement mental health education for its students. From the perspective of perceived affordance, the in-depth interview method was used to explore the perceptual logic of non-help-seeking students at a key university regarding its MHECC. Previous studies on this topic were quantitative in nature; the current study used a qualitative approach, as this can provide additional information about the reasons why young people do not seek help, which can differ from the information obtained through structured survey questions [ 13 ]. While the intention to seek or avoid mental health treatment does not always directly translate into the actual use of services [ 29 ], exploring such intentions still provides clear guidance for understanding actual service utilization. 3.2 Study participants and procedure The participants in this study were recruited by two researchers through purposive sampling in open elective courses related to emotion regulation offered to the whole university. Toward the end of the course, after a preliminary trust relationship had been established between the researchers and the students, a researcher explained the purpose of the study to the students. The criterion of “acknowledging that one has emotional distress but is still resisting seeking university counseling” was used to determine participant inclusion. Ultimately, 13 eligible students took the initiative to contact the researchers and became participants. All of them had experiences of dealing with emotional distress through various channels after entering the university, including talking to friends and family, seeking help from psychologists in hospitals, posting online for assistance, and looking for information in professional books. However, none of them had ever used the university’s counseling services. They were asked about the reasons for not seeking counseling from the perspective of perceived affordances. 3.3 Data collection All participants contacted the researchers privately and participated in the study on a voluntary basis. All signed hardcopy informed consent forms. To protect their privacy, the interviews were conducted one-on-one and face-to-face, for durations ranging from 30 minutes to two hours. All names mentioned in the transcripts were anonymized. The interview locations were chosen by the participants, with their comfort as the priority; the locations they chose were either the researchers’ dedicated offices or open yet quiet public spaces. The in-depth interview guide included: (1) “Do you think the services provided by the campus MHECC are useful? Why?” (2) “Do you know any of your classmates or friends who have used the services of the campus MHECC? How have their experiences or views influenced you?” (3) “What is your opinion of the counsellors at the campus MHECC? Do you think the counselling process should focus on offering advice or active listening?” (4) “What risks or concerns might you have about seeking services at the MHECC?” The researchers probed for further details as necessary and further clarify the participants’ views by restating them. Some interviews were recorded with the participants’ permission. These recordings were then anonymized and transcribed verbatim. For interviews where recording is not permitted, a post-interview immediate memo is held after the interview ends. The researchers attempt to reconstruct the core arguments and key direct quotes into a comprehensive narrative text. 3.4 Data analysis The two researchers adhered to the constructivist research paradigm, employing Braun and Clarke’s reflexive thematic analysis method [ 30 ]. Themes were extracted from the text through familiarizing the data, generating initial codes, forming themes through code clustering, and reviewing and refining themes. Researchers first jointly coded two texts to establish a preliminary coding framework, subsequently conducted independent coding, and finally reached a consensus on the coding through negotiation. Throughout the data analysis process, researchers proactively explored the potential impact of their dual roles as both researchers and teachers on the study findings by drafting memos. Given that the topics involved are sensitive ones related to emotional distress and mental health, there were only 13 participants. After the interviews of the first 11 participants, the themes were found to have repeatedly emerged and information redundancy occurred in data collection. The remaining 2 participants were interviewed to verify the robustness of the themes; and no new themes appeared. This may be due to the highly focused nature of our research questions, or the strong homogeneity of the participants’ personal backgrounds. 4. Findings: Negative perceived affordances The research findings are organized into themes and explore the negative perceived affordances of the campus MHECC among this group of college students, as derived from in-depth interviews (see Table 1 ). [Table 1 about here] Table 1 Summary of main findings Negative perceived affordances of the campus MHECC Theme Subthemes Examples of quotes Theme1: Surveillant services -Screening the target population “I’m worried that if I answer the questions in the assessment poorly, I’ll be labeled as someone with mental health issues.” (P09) -Instructors’ (fudaoyuan, 輔導員) additional care “If instructors know which students have psychological problems, they will definitely have frequent heart-to-heart talks with them.” (P07) -Surveillance results linked to advancement evaluation “If the Center were not associated with the university, I would go there.” (P01) Theme2: Counseling without empathy -Certificates without professional competence “I don't think those certificates represent professional competence. I could also pass the exams for those certificates if I were to take them, but that doesn’t mean I have the relevant ability.” (P03) -Standardized responses for meeting workload “The counselors and I are not in the same environment. They don’t understand how important this matter is to me, so it’s hard for them to truly empathize with me.” (P02) - “Teachers” with correct answers “We avoid seeking counseling because we dislike being lectured. What we prefer are conversations with self-disclosure—instead of always hearing, ‘you should do this’ or ‘you should do that’.” (P09) Theme3: Cautious peer support -High-visibility social evaluation pressure “I’ll never go there at all. It’s too easy to be spotted by others.” (P07) -Unbiased yet unapproachable peer support “If I saw them going for counseling, I wouldn’t get too close to them. I’m afraid that something I say or do might affect their mental state and lead to unnecessary troubles. If I think this way, others will definitely think the same.” (P05) 4.1 Surveillant services 4.1.1 Screening the target population The university’s MHECC organized a unified mental health survey for the purposes of psychological assessment. The survey aims to help students better understand their own psychological state, and to assist the MHECC in identifying students’ needs for mental health services. However, college students perceive this psychological assessment as merely a routine procedure, a task to be completed, or surveillance conducted by the MHECC: The Center is just trying to get the task done, and the assessment doesn’t offer any substantial help afterward. We really hoped they could provide a detailed assessment report tailored to each individual and guide us on what to do, but that’s not the case. (P02) Students’ expectations for psychological assessments go beyond simply wanting to know “what the results are”; they are more eager to understand “what to do next”. However, the MHECC only conducts the assessments, and does not use the assessment data in a transparent fashion. This leads students to feel that the psychological assessment data they provide not only fails to help them, but is instead used for the university’s screening and management of students: The assessment just asks us to fill out a scale. It feels like the Center is just collecting data and screening people with problems. (P06) Due to their concerns about the consequences of participating in psychological assessments, they often deliberately avoid selecting negative options: I took a psychological assessment when I enrolled. Since I didn’t know how this scale would affect me, I didn’t dare to answer truthfully. (P08) The above interview is not an isolated case. For instance, the MHECC took efforts to clarify the significance of its psychological assessments on its official WeChat account. It also promised that the psychological assessments are not diagnoses, but are merely intended to reflect students’ recent psychological state and will not affect their student status, Party membership application, awards, further education, or future employment. Furthermore, so long as students’ lives and safety are not endangered, an important principle guiding the daily work of the MHECC is to protect students’ privacy. Despite the many commitments mentioned above, the students still expressed the belief that these commitments can be broken at any time, because the MHECC is a department under the Student Affairs Office. As one student explained: “The Center is no different from other departments of the university. They all supervise us” (P06). 4.1.2 Instructors’ (fudaoyuan , 輔導員 ) additional care Like most universities and colleges in China, this key university has also established a four-level mental health network covering “university, school, class and dormitory”. Of these levels, the joint intervention between the university and schools is of the greatest importance. The information collaboration between the university’s MHECC and its schools often involves sharing information with the schools about students who have been identified through psychological assessments or counseling as requiring special attention. This enables instructors, who are full-time staff responsible for college students’ ideological education, daily management, and holistic development guidance, to provide additional care and daily intervention. The original intention of this measure was to integrate the university’s professional resources and the schools’ frontline advantages, and to coordinate multiple resources to strengthen support for students. However, this collaboration further reinforces students’ perception of the Center as having a surveillance function. As one student explained: I heard that a classmate was suffering from severe depression, and the teacher from the Center directly informed the instructor of his situation. The instructor then talked to him and advised him to seek medical treatment. After hearing such things, who would still want to go to the Center? (P01) Participants expect to obtain confidential, targeted, and professional support from the MHECC. However, they believe that once they seek counseling within the university system, they have no way to control the consequences. They “can only passively accept and respond negatively to a series of support measures imposed by the university, which are tinged with power control and discipline” [ 31 ]. Students learn from word-of-mouth information that under the collaboration between the university and colleges, the instructors’ support measures for key groups are often simplified into top-down, proactive interviews. This leads the respondents to regard the instructors’ intervention as being not only ineffective as a form of support, but also a downward extension of the MHECC’s supervisory function. 4.1.3 Surveillance results linked to advancement evaluation Once students perceive the psychological assessments and counseling services provided by the MHECC to be means for the university’s surveillance of individuals, they often worry that if the results of the assessments or counseling are negative, the processing path of these results will be opaque and the consequences will be uncontrollable. This perceived uncontrollability manifests not only in instructors’ top-down interview interventions, but also extends to implicit connections with students’ future education and employment. Consequently, students feel they are confronted with unpredictable risks that are hard to anticipate: Once, I told my close friend that I planned to go to the Center. He advised me not to go, saying there was no way to ensure that the faculty and staff in our college wouldn't find out. If they knew about it, that could potentially affect my future job search. Even though this was just something I'd heard, I still didn't dare to go . (P04) Even though the respondents’ concerns that surveillance indicating poor mental health may affect their education and employment are only based on hearsay, they nonetheless try their best to prevent the university from knowing such relevant information because they want to ensure the security of their further education and employment prospects. As a result, they either avoid seeking counseling or hide their real condition during the assessments in order to evade the perceived risks brought by the surveillance. Students with higher cultural capital are known to exhibit a future-oriented risk-aversion tendency [ 28 ]. Students at this key university also place a strong emphasis on academic performance and career prospects, which leads them to adopt a more cautious attitude toward the psychological assessments and counseling services provided by their university. The MHECC is part of the university system. Students believe that it prioritizes the university’s overall interests over the best interests of individual students. They also believe that the mental health services provided by the MHECC are untrustworthy because they pose potential risks to students’ best interests. Their concerns about surveillance have prompted them to seek help from outside: If I have any problems, I would rather go to the counseling department of a hospital than the Center. The hospital is more confidential and won’t disclose information to the university. (P10) 4.2 Counseling without empathy 4.2.1 Certificates without professional competence The MHECC provides detailed professional profiles of each of its counselors on its official WeChat account and bulletin boards, including such information as the counselors’ qualification certificates, areas of expertise, and work experience. From the students’ perspective, certificates mostly signify only that the counselors have met the minimal thresholds for qualification, and do not directly equate to professional competence: I have seen the counselors’ profiles on the official WeChat account. I only saw what certificates they hold. Having received a university education, we have already disenchanted ourselves with such certificates. If the counselors only provide services based on the knowledge they learned to get the certificates, they won't be able to truly solve our problems. Word-of-mouth is the most important thing, but we haven't heard anything about them so far. (P04) Students face specific and widespread forms of psychological distress such as academic pressure and interpersonal conflicts. They need to perceive essential, concrete information such as “whether similar problems can be solved” and “what methods counselors use to solve them”, by hearing about similar cases and the word-of-mouth provided by previous clients. However, the counselors’ professional certificates are merely reflections of the standardization of skills by educational bureaucratic organizations [ 32 ], and are discredited in the eyes of students at the key university who are skilled in taking exams. Thus, they hardly constitute effective proof of professional authority. 4.2.2 Standardized responses for meeting workload There are currently only seven full-time psychological counselors at the MHECC, while the number of students on campus exceeds 20,000, resulting in a severe imbalance between supply and demand. To address this, the MHECC has recruited psychology teachers and instructors from its campus to work as part-time psychological counselors. Even so, the university must still consider the rational allocation of its limited resources. According to the MHECC’s regulations, a student can have a maximum of eight counseling sessions per semester, and under normal circumstances, each session lasts one hour. One student expressed his dissatisfaction: The counseling may be helpful, but not for me. Because counselors don’t really understand me as a person or my life—and yet my emotional problems are closely tied to who I am and my life experiences. You put in so much effort to talk about everything, and by the time one hour is almost up, they might still not get the point. (P06) Participants generally believe that their personal emotional distress is closely related to their own lives, and thus their problems can only be solved if counselors provide personalized plans—specifically, potential support that is deeply tied to their own personality traits, life histories, and learning scenarios. However, university counseling is limited by its standardized process with a fixed duration and fixed number of sessions. The advice it provides is based more on counselors’ perspectives of standardized knowledge than on a deep understanding and integration with students’ life experiences, resulting in a mismatch between the perceived affordances and students’ actual needs. Furthermore, when recruiting part-time counselors, the MHECC clearly states that it provides subsidies to counselors ranging from 40 to 60 yuan per hour, based on their counseling hours and professional titles. This remuneration system takes time input rather than counseling effectiveness as its key evaluation metric, and thus, students believe it incentivizes counselors to prioritize meeting the university’s quantitative assessment indicators, rather than paying attention to counseling effectiveness and students’ feedback. As one student explained: Counselors focus on their own workload of one session per hour rather than the effectiveness of the counseling; therefore, the effectiveness will not be good. (P04) The quantified counseling duration and salary incentives lead to a perception among students that the current counseling services are limited to only acquiring individuals’ fragmented information and providing formulaic responses, while failing to make comprehensive judgments about individuals’ problems and provide personalized support. 4.2.3 “Teachers” with correct answers From the students’ perspective, the boundary between the roles of counselors and teachers is blurred, to such an extent that counselors tend to be primarily identified as teachers: In the university environment, I naturally perceive counselors as teachers. Contact persons for psychological service hotlines are often listed in the posts on the official WeChat account of the Center, and these contacts also refer to themselves as teachers. (P01) When students perceive that the counselor’s role as a teacher is significantly more prominent than their role as a counselor, they first recognize the traditional authority of a teacher (as one student described it: “A teacher is there to discipline students.” P02) rather than the professional authority of a counselor. One student’s statement powerfully illustrates the distinction between these two: The people you talk to are not just counselors, but teachers. Their professional instinct makes them only offer correct answers while ignoring your emotions, and that’s not what I want. What I desire more is the acceptance, understanding, and support from counselors. (P08) Students regard counselors as “directive authority figures” [ 33 ]. They tend to perceive that the counselors provide more of an authority-based lecture on right and wrong, rather than empathy-based advice from the perspective of a professional counselor. 4.3 Cautious peer support 4.3.1 High-visibility social evaluation pressure To enhance the accessibility and utilization rate of counseling services, the university has located its MHECC in an office building, which serves as a central area that is easily accessible to students. While this “proximity-based service” layout effectively meets students’ need for convenience, it also brings them unease because they anticipate being identified due to the high visibility of the area. As one student explained: I won't go to the Center. There are people everywhere around it. I don't want to be seen and mistaken for being judged as “mentally ill”, and leave others with a negative impression. (P06) In a university environment, there is frequent interaction among peer groups, and the MHECC is located in a crowded area. The intersection of these two factors creates a structural problem that leads students to naturally overestimate the likelihood of being encountered by acquaintances when they access mental health services. This can easily lead them to anticipate the negative labeling of “being judged as ‘mentally ill’”. Such labeling could undermine students’ impression management among their peers and ultimately lead to unfair treatment or gossip in their interpersonal interactions. The high visibility of counseling resulting from the MHECC’s central location is amplified in students’ perceptions into a social evaluation threat. Therefore, once students perceive that the MHECC affords a risk of being seen by acquaintances, they will develop concerns about being noticed and identified, triggering psychological anxiety. These concerns even extend to potential acquaintances they may meet in the future. As one student noted: Even if we don’t know each other now, there’s no guarantee we won’t meet someday. They might remember seeing you in that place, and that would be really awkward. (P07) Consequently, to maintain their positive personal image, they choose to forgo seeking counseling at the university: I would rather go to a hospital for help if I have problems than visit the Center. Because it’s located right in the university’s office building. As long as you go there, you can easily be recognized by classmates or teachers, which is really embarrassing. (P05) 4.3.2 Unbiased yet unapproachable peer support In a campus environment with dense, acquaintance-based social interactions, students strive to maintain an ideal self-image because they have a deep-seated fear of being categorized as “sensitive individuals”. When asked about what the most serious consequence of the MHECC’s high visibility might be, some students responded as follows: It is generally believed that there are more highly sensitive people who seek counseling, as they care more about what others say and get hurt easily. So I’m worried that if people see me going for counseling, they will also regard me as a highly sensitive person and treat me with excessive caution. It’s not exactly discrimination, but they will definitely keep their distance. (P04) Similarly, another student also expressed a similar view: If they see you seeking counseling, they won’t discriminate against you, but they won’t get close to you either. From then on, we can only be classmates, not friends. This kind of relationship is really hard to accept . (P02) On the one hand, the respondents clearly stated their belief that even if their classmates found out that they were seeking psychological help, they would not be discriminated against for it. Some even argued that “classmates who can be aware of their own emotions and take the initiative to seek counseling are very courageous” (P03). This indicates that the respondents’ campus environment has developed a relatively friendly atmosphere of support, and that they themselves hold an open and inclusive attitude toward seeking psychological help. On the other hand, however, the respondents expressed worry that once others became aware that they were seeking counseling, those people would start treating them “with excessive caution”. This would restrict their originally natural interactions to the level of superficial “classmate” relationships, making it difficult for them to advance to the stronger bond of “friendship”. Consequently, their need for emotional connection in the private sphere would not be satisfied. While there is no explicit discrimination in such cases, individuals may nonetheless encounter implicit exclusion through social distancing and thereby lose the possibility of developing deeper relationships and accessing effective peer support. By voicing concerns about peer support, the respondents indicate that they do not yet regard seeking counseling as a normal practice of self-care. This perception not only shapes their anticipation of the attitudes of others toward them, but also directly reflects their own attitudes toward others: If I knew a classmate was seeking counseling, I’d still be very cautious about interacting with them. I’m terrified that what I say or do might leave me with responsibilities I never could have anticipated. Putting myself in their shoes, I also worry that others would treat me the same way. (P08) All the respondents reported having experienced emotional distress in the past year. One possible explanation for why they perceive classmates who seek help through counseling as being vulnerable and thus adopt a “cautious” approach toward them is that, although they themselves have also encountered emotional distress, they were able to resolve those issues through non-counseling channels. This experience made them more likely to establish a cognitive association between seeking counseling and vulnerability, leading them to tend to adopt a strategy of actively distancing themselves from classmates who seek counseling because they want to avoid potential social risks, lest they fall into conflicts or become forced into assuming responsibilities. This also indicates that although few students openly endorse stigmatization, far more may implicitly subscribe to it [ 6 ]. Based on their own experiences, respondents form an attributional pattern and, by “putting themselves in others’ shoes”, infer that others hold the same evaluative logic. Consequently, when they perceive that counseling on campus is likely to expose their help-seeking behavior, they tend to proactively avoid counseling because they believe such exposure will threaten the group relationships and peer support they value. 5. Discussion Prior studies on the behavior of college students who experience mental health distress but do not actively seek help have mostly analyzed this phenomenon from a single dimension, focusing either on structural barriers or on attitudinal barriers. Even the attribution of low perceived need is expressed as the subjective attitude of individuals who do not feel the need for help. In essence, these studies place MHECCs and help-seekers in a binary oppositional analytical framework and ignore the interactive relationship between the two parties. This paper transcends this traditional, binary research paradigm by addressing the prior interactions between individuals and the MHECC, including negative experiences of filling out psychological scales, criticizing counselors’ qualifications, and examining the location of the MHECC. From the perspective of perceived affordances, this study focuses on the fact that individuals’ perception of the affordances of the MHECC is based on their own past experiences and cultural conventions, because the degree of an affordance exists relative to a particular user [ 25 ]. When discussing the affordances of artifacts, the relational properties of affordances mean that we must focus not only on “how” affordances work, but also on “under what circumstances” and “for whom” they work [ 34 ]. Having relatively high cultural capital, the students at the key university hold a positive attitude toward caring for their own mental health. They not only proactively choose to participate in open elective courses related to emotion regulation, but also show full respect and understanding to classmates who seek professional counseling. However, despite the continuous improvement in their acceptance of counseling, their negative perceived affordances of MHECC have become barriers for them to seek professional on-campus help. In essence, these barriers constitute the non-monetary costs that students have to consider when seeking counseling [ 6 ]. In particular, college students embedded in China’s collectivist culture highly value others’ attitudes toward them and their relationships with others, and this becomes a key issue when deciding whether to seek counseling [ 33 ]. They assume that “group connections are the best guarantee for an individual’s wellbeing” [ 35 ]. The benefit of meeting their personal mental health needs should exceed the costs incurred by the damage to their group connections, as the latter can further harm their own mental health. Social isolation is significantly associated with adverse mental health conditions such as depression and has been proven to be an important risk factor for emotional disorders [ 36 ]. Therefore, Chinese people who adhere to the traditional value of collectivism are less likely to seek mental health treatment [ 37 ]. This is also why matters related to counseling are generally not discussed publicly in China. Most respondents in this study reported relying on hearsay to make decisions about whether to seek counseling. However, in the campus environment, what is most often passed on by word-of-mouth tends to be negative information. This makes it difficult for news of positive cases of successful counseling to spread, further confirming the negative perceived affordance of those who are reluctant to seek help proactively, and thus it shapes these respondents’ sense of alienation toward the MHECC. In terms of mental health care, placing one-sided hope in self-relief may lead to more serious crises, and thus seeking professional services should be one of the coping methods chosen by young people [ 38 ]. Understanding how college students perceive the affordances of their universities’ MHECCs is crucial for encouraging them to seek help. Affordances stem not only from the objective attributes of the environment but also from the users’ subjective expectations and beliefs. Even if these subjective perceptions are inconsistent with the objective facts, they still become part of the affordances, thereby influencing users’ cognition and usage of things [ 39 ]. Whether individuals’ perception of the affordances of an MHECC is positive or not determines whether they will seek help from it. It is evident that the characteristics of a Center do not absolutely determine outcomes; instead, these characteristics may give rise to a range of potential consequences due to individual differences and varying contexts [ 40 ]. This implies that even if key universities provide very good counseling facilities and counselors, students who perceive their affordances as being poorly designed will still not use them. Therefore, when most students report having at least some hesitation about seeking treatment for emotional problems, the treatment gap among college students cannot be fully eliminated simply by increasing access to treatment [ 8 ]. Therefore, efforts should be made to optimize the perceived affordances of MHECCs based on universities’ campus environments, combined with the unique experiences and culture of college students. Notably, students with high cultural capital often are concerned that the counseling services offered by educational institutions pose potential threats to their own long-term educational plans and career goals. Thus, it is particularly important to convey to them the long-term benefits of early intervention and provide positive initial experiences, as this will shape their future decisions to seek help [ 28 ]. Students’ initial experiences do not start with the official beginning of counseling; any affordances they perceive before entering counseling are included in the experience, such as surveillant services, counseling without empathy, and cautious peer support under the high visibility of the Center. Therefore, if MHECCs can be perceived by users as having positive affordances upon initial contact, that will promote help-seeking behaviors. Moreover, in counseling, perceived benefits are known to have a greater impact on help-seeking behaviors than perceived barriers [ 5 ]. Perceptual benefit information that clearly indicates the affordances of the counseling center should be designed explicitly to enhance usability. Usable designs have information specifying affordances that account for users’ cultural conventions and level of expertise [ 25 ]. Good designers are responsible for enabling the accurate perception of MHECCs’ affordances through effective design decisions, ensuring that the perceived affordances align as closely as possible with their real affordances [ 24 ]. MHECCs at key universities are well-positioned to provide quality counseling facilities and counselors. The perceptual benefit information of these affordances should be clearly designed based on various attributes of college students, such as their experiences, knowledge, and cultural backgrounds, so as to enhance the Centers’ usability. Study limitations Our study was conducted at a key university in China, which affects the transferability of the final research results to other universities [ 41 ], especially non-key universities. Given that this study’s research involves sensitive topics related to emotional distress and mental health, trust-based face-to-face interviews were used, as they enabled timely follow-up questions on meaningful topics, enriched the experiential data, and deepened the research questions. However, the number of recruited participants was relatively limited. The composition of the current sample may not fully capture all the potential heterogeneity of the research phenomenon. For instance, the perspectives of potential participants who were unwilling to undergo face-to-face interviews due to a lack of trust in the researchers have not been represented in this study. This limitation is expected to be addressed in subsequent research by adopting recruitment strategies such as online anonymous platforms. 6. Conclusions Some students at the key university, constrained by their own experiences and cultural backgrounds, hold negative perceived affordances toward the Center. Even if these perceived affordances are inconsistent with the real affordances, they still mean that these students do not take the initiative to seek professional help there. To enhance the usability of the Center, the perceived information regarding the Center’s affordances should be optimized based on college students’ experiences and cultural backgrounds. College students are the first to assess their own mental health. If they can perceive the positive affordances of MHECCs, they will take the initiative to seek help, and this will enable the early detection and timely intervention into their mental health problems. Timely intervention and support bring well-being to both individuals and society as a whole. The findings of this study can not only provide important references for Chinese universities to comprehensively promote students’ mental well-being in the new era, based on the educational philosophy of “Health First”, but also offer a new analytical perspective and practical insights for optimizing and improving mental health service systems in universities worldwide. Abbreviations MHECC Mental health education and counseling center Declarations Ethics approval and consent to participate This study was conducted in accordance with the ethical principles of the Declaration of Helsinki. Ethical approval was obtained from the Institutional Ethics Committee of the Clinical Study of the First Hospital of Lanzhou University (Ethics Approval Number: LDYYLL2024-311). Consent for publication Not applicable. Competing interests The authors declare no competing interests. Funding No funding was received for conducting this study. Author Contribution Xiaofang Jin: conceptualization, methodology, study design, investigation and analysis, writing original draft. Furong Lian: methodology and investigation. All authors have reviewed and approved the submission of the manuscript for publication. Acknowledgement We would like to express our sincere gratitude to all participants for their generous contributions, which made this study possible. Data availability Not applicable. References Eisenberg D, Golberstein E, Hunt JB. Mental health and academic success in college. B E J Economic Anal Policy. 2009;9(1). https://doi.org/10.2202/1935-1682.2191 . Ishii T, Tachikawa H, Shiratori Y, Hori T, Aiba M, Kuga K, Arai T. What kinds of factors affect the academic outcomes of university students with mental disorders? A retrospective study based on medical records. Asian J Psychiatry. 2018;32:67–72. https://doi.org/10.1016/j.ajp.2017.11.017 . 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Encoding and decoding affordances: Stuart Hall and interactive media technologies. Media Cult Soc. 2017;39(4):592–602. https://doi.org/10.1177/0163443717692741 . Yuan HM. Establishing a Mental Health Education System in Colleges and Universities with Chinese Characteristics. China High Educ. 2022; (24): 41–3. Billings KR, Young KM. How Cultural Capital Shapes Mental Health Care Seeking in College. Sociological Perspectives. 2022; 65(4): 637–60. https://doi.org/10.1177/07311214211042856 Webb TL, Sheeran P. Does Changing Behavioral Intentions Engender Behavior Change? A Meta-Analysis of the Experimental Evidence. Psychol Bull. 2006;132(2):249–68. https://doi.org/10.1037/0033-2909.132.2.249 . Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Res Psychol. 2006;3(2):77–101. https://doi.org/10.1191/1478088706qp063oa . Yan ZL, Zhang GL, Role. Power and Culture: depressed college students' rejection of college psychological services. Youth Stud. 2025; (01): 115–34. Collins R, Cottom TM, Stevens ML. The Credential Society: An Historical Sociology of Education and Stratification. Columbia University; 2019. Song X, Anderson T, Himawan L, McClintock A, Jiang Y, McCarrick S. An investigation of a cultural help-seeking model for professional psychological services with U.S. and Chinese samples. J Cross-Cult Psychol. 2019;50(9):1027–49. https://doi.org/10.1177/0022022119878506 . Davis JL, Chouinard JB. Theorizing affordances: from request to refuse. Bulleting Sci Technol Soc. 2016;36(4):241–8. https://doi.org/10.1177/0270467617714944 . Newman DM, Sociology. Exploring the Architecture of Everyday Life, Twelfth Edition. Thousand Oaks: SAGE Publications; 2018. p.175. Cacioppo JT, Hawkley LC, Thisted RA. Perceived Social Isolation Makes Me Sad: 5-year Cross-lagged Analyses of Loneliness and Depressive Symptomatology in the Chicago Health, Aging, and Social Relations Study. Psychol Aging. 2010;25(2):453–63. https://doi.org/10.1037/a0017216 . Wang HP. Barriers to Chinese college students seeking psychological help from professionals. ETD Collection for University of Nebraska-Lincoln. 2013. https://digitalcommons.unl.edu/dissertations/AAI3590994 Ishikawa A, Rickwood D, Bariola E, Bhullar N. Autonomy versus support: self-reliance and help-seeking for mental health problems in young people. Soc Psychiatry Psychiatr Epidemiol. 2023;58(3):489–99. https://doi.org/10.1007/s00127-022-02361-4 . Nagy P, Neff G. Imagined Affordance: Reconstructing a Keyword for Communication Theory. Social Media Soc. 2015;1(2):1–9. https://doi.org/10.1177/2056305115603385 . Evans SK, Pearce KE, Vitak J, Treem JW. Explicating affordances: a conceptual framework for understanding affordances in communication research. J Computer-Mediated Communication. 2017;22(1):35–52. https://doi.org/10.1111/jcc4.12180 . Luu X, Rathjens C, Swadling M, Gresham B, Hockman L, Scott–Young C, Leifels Katrin, Zadow AJ, Dollard MF, Kent L. How university climate impacts psychosocial safety, psychosocial risk, and mental health among staff in Australian higher education: a qualitative study. High Educ. 2025;90:1273–90. https://doi.org/10.1007/s10734-024-01376-x . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 18 Feb, 2026 Editor invited by journal 27 Jan, 2026 Editor assigned by journal 21 Jan, 2026 Submission checks completed at journal 21 Jan, 2026 First submitted to journal 20 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8648425","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":593684859,"identity":"8550fb5f-6134-4b97-95fd-7a829d508cc9","order_by":0,"name":"Xiaofang Jin","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAtElEQVRIiWNgGAWjYBACxmYgUVFhAeZIEK/lzBkJErSAwdk2UrQwt/Mekzg4T8Le4ADzwds8DHZ5RDiML9ng4DYJZoMDbMnWPAzJxURo4TF8/HGbBJvBAR4zaR6GA4kNRGgxOHBwjgSQ5P9GtBbDBwcbJCSAtrARrcXY4MAxCQPJw2zGlnMMkglrMew/YyZxoMbGnu9488MbbyrsiNACV8EMIgwIqQcCeSLUjIJRMApGwUgHANLQNHdNmRUbAAAAAElFTkSuQmCC","orcid":"","institution":"Lanzhou University","correspondingAuthor":true,"prefix":"","firstName":"Xiaofang","middleName":"","lastName":"Jin","suffix":""},{"id":593684860,"identity":"cb79146b-815b-46f4-ad89-861e2c14e139","order_by":1,"name":"Furong Lian","email":"","orcid":"","institution":"Lanzhou University","correspondingAuthor":false,"prefix":"","firstName":"Furong","middleName":"","lastName":"Lian","suffix":""}],"badges":[],"createdAt":"2026-01-20 11:19:35","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8648425/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8648425/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":105561991,"identity":"0dd7dafe-51e6-4c99-a7bf-c6e12b6d8b6b","added_by":"auto","created_at":"2026-03-27 12:23:40","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":993624,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8648425/v1/00499d7d-8d62-4a29-afb1-af5691613b4e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"It may be helpful, but not for me: A qualitative study of the perceived affordances of a mental health education and counseling center among students at a key university in China","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eUniversities\u0026rsquo; efforts at health education crucially depend on understanding their students\u0026rsquo; mental health problems and coping strategies. The presence of mental health problems during the college years causes problems such as lower academic achievement [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], and higher dropout rates [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], thereby undermining the effective development of human capital. The college years are also a peak period for the first onset of a range of mental disorders [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Approximately three-quarters of cases of lifelong mental disorders first appear by the age of 24 [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. If not taken seriously and addressed proactively, mental disorders can lead to a series of serious consequences such as poor quality of life, social isolation, and even suicide [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Even so, most college students with mental disorders do not receive treatment [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe Blue Book of \u003cem\u003eThe Report on the Development of National Mental Health in China\u003c/em\u003e (\u003cem\u003e2023\u0026ndash;2024\u003c/em\u003e), jointly released by the Institute of Psychology of the Chinese Academy of Sciences and China Social Sciences Press, indicates that in the past year, even though 80% of college students are aware that their schools provide free counseling services, only 2.8% have actually used such services. Even among those at high risk for depression, who have a stronger potential need for counseling, the utilization rate is a mere 9.3%. The \u003cem\u003eSurvey Report on the Mental Health Status of Chinese College Students in 2022\u003c/em\u003e emphasizes that students from key universities, which are designated and preferentially supported by the state for their outstanding academic performance, face a higher risk of depression and anxiety than those from non-key universities. Consequently, the counseling needs of key university students and their utilization of mental health services deserve greater attention. In April 2023, the Ministry of Education of the People\u0026rsquo;s Republic of China, together with 17 relevant departments, jointly issued the \u003cem\u003eSpecial Action Plan for Comprehensively Strengthening and Improving Students\u0026rsquo; Mental Health Work in the New Era (2023\u0026ndash;2025)\u003c/em\u003e. This plan points out that the rapid development of China\u0026rsquo;s economy and society, accompanied by constant changes in the environment for students\u0026rsquo; growth, means that students\u0026rsquo; mental health problems have become more prominent. For this reason, under the guidance of the educational philosophy of \u0026ldquo;Health First\u0026rdquo;, it is necessary to comprehensively strengthen and improve students\u0026rsquo; mental well-being in the new era.\u003c/p\u003e \u003cp\u003eAgainst this backdrop, there is an imperative need to gain an in-depth understanding of why there is an imbalance between the demand for on-campus counseling and its use by students at key universities, so as to increase counseling service utilization rate and expanding the group of beneficiaries.\u003c/p\u003e"},{"header":"2. Previous Research","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Low willingness of college students to receive mental health services\u003c/h2\u003e \u003cp\u003eHigher education provides an ideal environment for addressing college students\u0026rsquo; mental health problems [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. The college campus environment typically offers rich, diverse, and interconnected resources that can exert a positive impact on students\u0026rsquo; mental health during their college years and beyond. However, the proportion of college students with common mental disorders who actually receive professional treatment remains very small [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. In one study, only a quarter of college students stated that they would definitely seek treatment if they experienced emotional problems [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Another found that two-thirds of college students facing mental health problems did not seek any treatment in the past year [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. A survey specifically targeting postgraduate students found that the utilization rate of mental health services in that group was far lower than the apparent demand [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. One reason for this low utilization rate is college students\u0026rsquo; greater willingness to seek help from informal social networks than from formal mental health services [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Barriers to college students seeking mental health services\u003c/h2\u003e \u003cdiv id=\"Sec5\" class=\"Section3\"\u003e \u003ch2\u003e2.2.1 \u003cem\u003eStructural barriers and attitudinal barriers\u003c/em\u003e\u003c/h2\u003e \u003cp\u003eCollege students who have not received mental health treatment face barriers such as believing that their problems will improve on their own, questioning the severity of their own problems, a lack of time for seeking treatment, perceived stigma, and attempting to solve the problems by themselves [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Of the barriers they face, factors such as cost, expected time investment, transportation, and scheduling are structural barriers, while tendencies to handle problems on one\u0026rsquo;s own, preference to talk to friends or relatives, and feelings of excessive awkwardness are attitudinal barriers [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. In countries where resources are limited, the primary means to reduce the gap in mental health services is to eliminate structural barriers by improving the availability and accessibility of services [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Even in countries with relatively sufficient treatment resources, the increasing incidence of mental disorders means that resources must still be expanded or reallocated to reduce the proportion of untreated students [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. However, for college students who need mental health treatment but have not received it, attitudinal barriers are more common than structural ones [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Stigma, embarrassment, lack of mental health knowledge, and a preference for self-reliance are the most significant attitudinal barriers for young people seeking help [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Whether or not they seek help when faced with emotional problems in the future depends more on attitudinal barriers than on structural barriers [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. College students will not use mental health services if they do not believe that psychiatrists have received professional training and consider the quality of the provided services to be poor [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Therefore, the reason why more students who need treatment do not receive it is not the lack of treatment opportunities, but is instead their perception that campus mental health resources have little value [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. If they perceive the staff of the campus mental health centers as being unfriendly or untrustworthy, they will be especially deterred from seeking help [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003e2.2.2 \u003cem\u003eLow perceived need\u003c/em\u003e\u003c/h2\u003e \u003cp\u003eIn addition to the aforementioned structural barriers and attitudinal barriers, another reason why young people do not seek professional psychological help is that their perceived need is low [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Among college students, a low perception of the need for help is known to directly affect their actual help-seeking behavior [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Many college students do not seek treatment because they perceive mental health problems as being common reactions to the stress of university life [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], or if they believe they can handle their psychological distress on their own [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], or if alternative options are available that they perceive as being less stigmatizing [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Low perceived need and the desire to handle problems on one\u0026rsquo;s own are recognized to be significant barriers that lead students to consider either delaying help-seeking or not seeking help at all [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Perceived affordance as a form of theoretical support\u003c/h2\u003e \u003cp\u003eThe concept of \u0026ldquo;affordance\u0026rdquo; was first proposed by the American ecological psychologist J. J. Gibson in his book \u003cem\u003eThe Ecological Approach to Visual Perception\u003c/em\u003e, first published in 1979. He defined affordances as follows: \u0026ldquo;the \u003cem\u003eaffordances\u003c/em\u003e of the environment are what it offers the animal, what it provides or furnishes, either for good or ill\u0026rdquo; [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. An affordance reflects the interrelationship and interaction between the environment and the actor, and the concept of affordance is used to explain the possibilities of engaging in different behaviors in a given environment. Although the manifestation of an affordance relies heavily on the actor\u0026rsquo;s perception, an affordance still exists even when it is not perceived [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eNorman offered a different view on this, arguing that \u0026ldquo;an affordance is a relationship between the properties of an object and the capabilities of the agent that determine just how the object could possibly be used\u0026rdquo; [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Since an affordance determines the possible ways in which an object can be used, it must be perceivable if it is to be relevant to the effective prediction of actions. However, poor design prevents an affordance from being directly perceived, and an affordance that cannot be perceived is of no use [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Thus, in terms of affordances, the actor\u0026rsquo;s perception of a thing is more important than the characteristics of the thing itself. The perceived affordances, which \u0026ldquo;result from the mental interpretation of things, based on our past knowledge and experience applied to our perception of the things about us\u0026rdquo; [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], determine the usability of things [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Therefore, based on usability, the perceived affordances proposed by Norman are tightly coupled with the actor\u0026rsquo;s past experience, knowledge, and culture. This differs from the Gibsonian definition of affordances, which is \u0026ldquo;independent of the actor\u0026rsquo;s experience, knowledge, culture, or ability to perceive\u0026rdquo; [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Norman considers an affordance to be highly interpretive, and how one interprets the purpose of a thing is directly related to the actor\u0026rsquo;s position [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. In other words, \u0026ldquo;the interpretation of a perceived affordance is a cultural convention\u0026rdquo; [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], which may lead to an inconsistency between the perceived affordances of a thing and its real affordances [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eUsing the analytical tool of perceived affordances, what we are interested in is the following paradox: Mental Health Education and Counseling Centers (MHECCs) are widely established at Chinese universities, especially key universities, which provide free and continuously optimized psychological counseling services to meet the diverse needs of students [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Moreover, students in these universities have weaker perceived stigma toward psychological counseling [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Nevertheless, why is the utilization rate of counseling centers still low among some students with actual needs? What affordances do students at key universities perceive in their interactions with MHECCs, and how do their past knowledge, experiences, and cultural background influence this perception? This study takes a closer look at these perceived affordances in order to reveal the fundamental causes of the low utilization rates of MHECCs. Note that this phenomenon has not been satisfactorily explained by previous one-sided analyses, which have focused on structural barriers, attitudinal barriers, and low perceived need.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Methods","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Ethics and study design\u003c/h2\u003e \u003cp\u003e This study was approved by the Institutional Ethics Committee of the Clinical Study of the First Hospital of Lanzhou University (Ethics Approval Number: LDYYLL2024-311). It was conducted at a key university, the MHECC of which was established in the 1980s; it is one of the first institutions of higher education in China to implement mental health education for its students.\u003c/p\u003e \u003cp\u003eFrom the perspective of perceived affordance, the in-depth interview method was used to explore the perceptual logic of non-help-seeking students at a key university regarding its MHECC. Previous studies on this topic were quantitative in nature; the current study used a qualitative approach, as this can provide additional information about the reasons why young people do not seek help, which can differ from the information obtained through structured survey questions [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. While the intention to seek or avoid mental health treatment does not always directly translate into the actual use of services [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], exploring such intentions still provides clear guidance for understanding actual service utilization.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Study participants and procedure\u003c/h2\u003e \u003cp\u003eThe participants in this study were recruited by two researchers through purposive sampling in open elective courses related to emotion regulation offered to the whole university. Toward the end of the course, after a preliminary trust relationship had been established between the researchers and the students, a researcher explained the purpose of the study to the students. The criterion of \u0026ldquo;acknowledging that one has emotional distress but is still resisting seeking university counseling\u0026rdquo; was used to determine participant inclusion. Ultimately, 13 eligible students took the initiative to contact the researchers and became participants. All of them had experiences of dealing with emotional distress through various channels after entering the university, including talking to friends and family, seeking help from psychologists in hospitals, posting online for assistance, and looking for information in professional books. However, none of them had ever used the university\u0026rsquo;s counseling services. They were asked about the reasons for not seeking counseling from the perspective of perceived affordances.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Data collection\u003c/h2\u003e \u003cp\u003eAll participants contacted the researchers privately and participated in the study on a voluntary basis. All signed hardcopy informed consent forms. To protect their privacy, the interviews were conducted one-on-one and face-to-face, for durations ranging from 30 minutes to two hours. All names mentioned in the transcripts were anonymized. The interview locations were chosen by the participants, with their comfort as the priority; the locations they chose were either the researchers\u0026rsquo; dedicated offices or open yet quiet public spaces. The in-depth interview guide included:\u003c/p\u003e \u003cp\u003e(1) \u0026ldquo;Do you think the services provided by the campus MHECC are useful? Why?\u0026rdquo;\u003c/p\u003e \u003cp\u003e(2) \u0026ldquo;Do you know any of your classmates or friends who have used the services of the campus MHECC? How have their experiences or views influenced you?\u0026rdquo;\u003c/p\u003e \u003cp\u003e(3) \u0026ldquo;What is your opinion of the counsellors at the campus MHECC? Do you think the counselling process should focus on offering advice or active listening?\u0026rdquo;\u003c/p\u003e \u003cp\u003e(4) \u0026ldquo;What risks or concerns might you have about seeking services at the MHECC?\u0026rdquo;\u003c/p\u003e \u003cp\u003eThe researchers probed for further details as necessary and further clarify the participants\u0026rsquo; views by restating them. Some interviews were recorded with the participants\u0026rsquo; permission. These recordings were then anonymized and transcribed verbatim. For interviews where recording is not permitted, a post-interview immediate memo is held after the interview ends. The researchers attempt to reconstruct the core arguments and key direct quotes into a comprehensive narrative text.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e3.4 Data analysis\u003c/h2\u003e \u003cp\u003eThe two researchers adhered to the constructivist research paradigm, employing Braun and Clarke\u0026rsquo;s reflexive thematic analysis method [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Themes were extracted from the text through familiarizing the data, generating initial codes, forming themes through code clustering, and reviewing and refining themes. Researchers first jointly coded two texts to establish a preliminary coding framework, subsequently conducted independent coding, and finally reached a consensus on the coding through negotiation. Throughout the data analysis process, researchers proactively explored the potential impact of their dual roles as both researchers and teachers on the study findings by drafting memos.\u003c/p\u003e \u003cp\u003eGiven that the topics involved are sensitive ones related to emotional distress and mental health, there were only 13 participants. After the interviews of the first 11 participants, the themes were found to have repeatedly emerged and information redundancy occurred in data collection. The remaining 2 participants were interviewed to verify the robustness of the themes; and no new themes appeared. This may be due to the highly focused nature of our research questions, or the strong homogeneity of the participants\u0026rsquo; personal backgrounds.\u003c/p\u003e \u003c/div\u003e"},{"header":"4. Findings: Negative perceived affordances","content":"\u003cp\u003eThe research findings are organized into themes and explore the negative perceived affordances of the campus MHECC among this group of college students, as derived from in-depth interviews (see Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e[Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e about here]\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSummary of main findings\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eNegative perceived affordances of the campus MHECC\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTheme\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSubthemes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eExamples of quotes\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eTheme1: Surveillant services\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-Screening the target population\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026ldquo;I\u0026rsquo;m worried that if I answer the questions in the assessment poorly, I\u0026rsquo;ll be labeled as someone with mental health issues.\u0026rdquo; (P09)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-Instructors\u0026rsquo; (fudaoyuan, 輔導員) additional care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026ldquo;If instructors know which students have psychological problems, they will definitely have frequent heart-to-heart talks with them.\u0026rdquo; (P07)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-Surveillance results linked to advancement evaluation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026ldquo;If the Center were not associated with the university, I would go there.\u0026rdquo; (P01)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eTheme2: Counseling without empathy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-Certificates without professional competence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026ldquo;I don't think those certificates represent professional competence. I could also pass the exams for those certificates if I were to take them, but that doesn\u0026rsquo;t mean I have the relevant ability.\u0026rdquo; (P03)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-Standardized responses for meeting workload\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026ldquo;The counselors and I are not in the same environment. They don\u0026rsquo;t understand how important this matter is to me, so it\u0026rsquo;s hard for them to truly empathize with me.\u0026rdquo; (P02)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e- \u0026ldquo;Teachers\u0026rdquo; with correct answers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026ldquo;We avoid seeking counseling because we dislike being lectured. What we prefer are conversations with self-disclosure\u0026mdash;instead of always hearing, \u0026lsquo;you should do this\u0026rsquo; or \u0026lsquo;you should do that\u0026rsquo;.\u0026rdquo; (P09)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTheme3: Cautious peer support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-High-visibility social evaluation pressure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026ldquo;I\u0026rsquo;ll never go there at all. It\u0026rsquo;s too easy to be spotted by others.\u0026rdquo; (P07)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-Unbiased yet unapproachable peer support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026ldquo;If I saw them going for counseling, I wouldn\u0026rsquo;t get too close to them. I\u0026rsquo;m afraid that something I say or do might affect their mental state and lead to unnecessary troubles. If I think this way, others will definitely think the same.\u0026rdquo; (P05)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e4.1 Surveillant services\u003c/h2\u003e \u003cdiv id=\"Sec15\" class=\"Section3\"\u003e \u003ch2\u003e4.1.1 \u003cem\u003eScreening the target population\u003c/em\u003e\u003c/h2\u003e \u003cp\u003eThe university\u0026rsquo;s MHECC organized a unified mental health survey for the purposes of psychological assessment. The survey aims to help students better understand their own psychological state, and to assist the MHECC in identifying students\u0026rsquo; needs for mental health services. However, college students perceive this psychological assessment as merely a routine procedure, a task to be completed, or surveillance conducted by the MHECC:\u003c/p\u003e \u003cp\u003e \u003cem\u003eThe Center is just trying to get the task done, and the assessment doesn\u0026rsquo;t offer any substantial help afterward. We really hoped they could provide a detailed assessment report tailored to each individual and guide us on what to do, but that\u0026rsquo;s not the case. (P02)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eStudents\u0026rsquo; expectations for psychological assessments go beyond simply wanting to know \u0026ldquo;what the results are\u0026rdquo;; they are more eager to understand \u0026ldquo;what to do next\u0026rdquo;. However, the MHECC only conducts the assessments, and does not use the assessment data in a transparent fashion. This leads students to feel that the psychological assessment data they provide not only fails to help them, but is instead used for the university\u0026rsquo;s screening and management of students:\u003c/p\u003e \u003cp\u003e \u003cem\u003eThe assessment just asks us to fill out a scale. It feels like the Center is just collecting data and screening people with problems. (P06)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eDue to their concerns about the consequences of participating in psychological assessments, they often deliberately avoid selecting negative options:\u003c/p\u003e \u003cp\u003e \u003cem\u003eI took a psychological assessment when I enrolled. Since I didn\u0026rsquo;t know how this scale would affect me, I didn\u0026rsquo;t dare to answer truthfully. (P08)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eThe above interview is not an isolated case. For instance, the MHECC took efforts to clarify the significance of its psychological assessments on its official WeChat account. It also promised that the psychological assessments are not diagnoses, but are merely intended to reflect students\u0026rsquo; recent psychological state and will not affect their student status, Party membership application, awards, further education, or future employment. Furthermore, so long as students\u0026rsquo; lives and safety are not endangered, an important principle guiding the daily work of the MHECC is to protect students\u0026rsquo; privacy. Despite the many commitments mentioned above, the students still expressed the belief that these commitments can be broken at any time, because the MHECC is a department under the Student Affairs Office. As one student explained: \u0026ldquo;The Center is no different from other departments of the university. They all supervise us\u0026rdquo; (P06).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section3\"\u003e \u003ch2\u003e4.1.2 \u003cem\u003eInstructors\u0026rsquo; (fudaoyuan\u003c/em\u003e, 輔導員\u003cem\u003e) additional care\u003c/em\u003e\u003c/h2\u003e \u003cp\u003eLike most universities and colleges in China, this key university has also established a four-level mental health network covering \u0026ldquo;university, school, class and dormitory\u0026rdquo;. Of these levels, the joint intervention between the university and schools is of the greatest importance. The information collaboration between the university\u0026rsquo;s MHECC and its schools often involves sharing information with the schools about students who have been identified through psychological assessments or counseling as requiring special attention. This enables instructors, who are full-time staff responsible for college students\u0026rsquo; ideological education, daily management, and holistic development guidance, to provide additional care and daily intervention. The original intention of this measure was to integrate the university\u0026rsquo;s professional resources and the schools\u0026rsquo; frontline advantages, and to coordinate multiple resources to strengthen support for students. However, this collaboration further reinforces students\u0026rsquo; perception of the Center as having a surveillance function. As one student explained:\u003c/p\u003e \u003cp\u003e \u003cem\u003eI heard that a classmate was suffering from severe depression, and the teacher from the Center directly informed the instructor of his situation. The instructor then talked to him and advised him to seek medical treatment. After hearing such things, who would still want to go to the Center? (P01)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eParticipants expect to obtain confidential, targeted, and professional support from the MHECC. However, they believe that once they seek counseling within the university system, they have no way to control the consequences. They \u0026ldquo;can only passively accept and respond negatively to a series of support measures imposed by the university, which are tinged with power control and discipline\u0026rdquo; [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Students learn from word-of-mouth information that under the collaboration between the university and colleges, the instructors\u0026rsquo; support measures for key groups are often simplified into top-down, proactive interviews. This leads the respondents to regard the instructors\u0026rsquo; intervention as being not only ineffective as a form of support, but also a downward extension of the MHECC\u0026rsquo;s supervisory function.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section3\"\u003e \u003ch2\u003e4.1.3 \u003cem\u003eSurveillance results linked to advancement evaluation\u003c/em\u003e\u003c/h2\u003e \u003cp\u003eOnce students perceive the psychological assessments and counseling services provided by the MHECC to be means for the university\u0026rsquo;s surveillance of individuals, they often worry that if the results of the assessments or counseling are negative, the processing path of these results will be opaque and the consequences will be uncontrollable. This perceived uncontrollability manifests not only in instructors\u0026rsquo; top-down interview interventions, but also extends to implicit connections with students\u0026rsquo; future education and employment. Consequently, students feel they are confronted with unpredictable risks that are hard to anticipate:\u003c/p\u003e \u003cp\u003e \u003cem\u003eOnce, I told my close friend that I planned to go to the Center. He advised me not to go, saying there was no way to ensure that the faculty and staff in our college wouldn't find out. If they knew about it, that could potentially affect my future job search. Even though this was just something I'd heard, I still didn't dare to go\u003c/em\u003e. \u003cem\u003e(P04)\u003c/em\u003e\u003c/p\u003e \u003cp\u003eEven though the respondents\u0026rsquo; concerns that surveillance indicating poor mental health may affect their education and employment are only based on hearsay, they nonetheless try their best to prevent the university from knowing such relevant information because they want to ensure the security of their further education and employment prospects. As a result, they either avoid seeking counseling or hide their real condition during the assessments in order to evade the perceived risks brought by the surveillance. Students with higher cultural capital are known to exhibit a future-oriented risk-aversion tendency [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eStudents at this key university also place a strong emphasis on academic performance and career prospects, which leads them to adopt a more cautious attitude toward the psychological assessments and counseling services provided by their university. The MHECC is part of the university system. Students believe that it prioritizes the university\u0026rsquo;s overall interests over the best interests of individual students. They also believe that the mental health services provided by the MHECC are untrustworthy because they pose potential risks to students\u0026rsquo; best interests. Their concerns about surveillance have prompted them to seek help from outside:\u003c/p\u003e \u003cp\u003e \u003cem\u003eIf I have any problems, I would rather go to the counseling department of a hospital than the Center. The hospital is more confidential and won\u0026rsquo;t disclose information to the university. (P10)\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003e4.2 Counseling without empathy\u003c/h2\u003e \u003cdiv id=\"Sec19\" class=\"Section3\"\u003e \u003ch2\u003e4.2.1 \u003cem\u003eCertificates without professional competence\u003c/em\u003e\u003c/h2\u003e \u003cp\u003eThe MHECC provides detailed professional profiles of each of its counselors on its official WeChat account and bulletin boards, including such information as the counselors\u0026rsquo; qualification certificates, areas of expertise, and work experience. From the students\u0026rsquo; perspective, certificates mostly signify only that the counselors have met the minimal thresholds for qualification, and do not directly equate to professional competence:\u003c/p\u003e \u003cp\u003e \u003cem\u003eI have seen the counselors\u0026rsquo; profiles on the official WeChat account. I only saw what certificates they hold. Having received a university education, we have already disenchanted ourselves with such certificates. If the counselors only provide services based on the knowledge they learned to get the certificates, they won't be able to truly solve our problems. Word-of-mouth is the most important thing, but we haven't heard anything about them so far. (P04)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eStudents face specific and widespread forms of psychological distress such as academic pressure and interpersonal conflicts. They need to perceive essential, concrete information such as \u0026ldquo;whether similar problems can be solved\u0026rdquo; and \u0026ldquo;what methods counselors use to solve them\u0026rdquo;, by hearing about similar cases and the word-of-mouth provided by previous clients. However, the counselors\u0026rsquo; professional certificates are merely reflections of the standardization of skills by educational bureaucratic organizations [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e], and are discredited in the eyes of students at the key university who are skilled in taking exams. Thus, they hardly constitute effective proof of professional authority.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section3\"\u003e \u003ch2\u003e4.2.2 \u003cem\u003eStandardized responses for meeting workload\u003c/em\u003e\u003c/h2\u003e \u003cp\u003eThere are currently only seven full-time psychological counselors at the MHECC, while the number of students on campus exceeds 20,000, resulting in a severe imbalance between supply and demand. To address this, the MHECC has recruited psychology teachers and instructors from its campus to work as part-time psychological counselors. Even so, the university must still consider the rational allocation of its limited resources. According to the MHECC\u0026rsquo;s regulations, a student can have a maximum of eight counseling sessions per semester, and under normal circumstances, each session lasts one hour. One student expressed his dissatisfaction:\u003c/p\u003e \u003cp\u003e \u003cem\u003eThe counseling may be helpful, but not for me. Because counselors don\u0026rsquo;t really understand me as a person or my life\u0026mdash;and yet my emotional problems are closely tied to who I am and my life experiences. You put in so much effort to talk about everything, and by the time one hour is almost up, they might still not get the point. (P06)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eParticipants generally believe that their personal emotional distress is closely related to their own lives, and thus their problems can only be solved if counselors provide personalized plans\u0026mdash;specifically, potential support that is deeply tied to their own personality traits, life histories, and learning scenarios. However, university counseling is limited by its standardized process with a fixed duration and fixed number of sessions. The advice it provides is based more on counselors\u0026rsquo; perspectives of standardized knowledge than on a deep understanding and integration with students\u0026rsquo; life experiences, resulting in a mismatch between the perceived affordances and students\u0026rsquo; actual needs.\u003c/p\u003e \u003cp\u003eFurthermore, when recruiting part-time counselors, the MHECC clearly states that it provides subsidies to counselors ranging from 40 to 60 yuan per hour, based on their counseling hours and professional titles. This remuneration system takes time input rather than counseling effectiveness as its key evaluation metric, and thus, students believe it incentivizes counselors to prioritize meeting the university\u0026rsquo;s quantitative assessment indicators, rather than paying attention to counseling effectiveness and students\u0026rsquo; feedback. As one student explained:\u003c/p\u003e \u003cp\u003e \u003cem\u003eCounselors focus on their own workload of one session per hour rather than the effectiveness of the counseling; therefore, the effectiveness will not be good. (P04)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eThe quantified counseling duration and salary incentives lead to a perception among students that the current counseling services are limited to only acquiring individuals\u0026rsquo; fragmented information and providing formulaic responses, while failing to make comprehensive judgments about individuals\u0026rsquo; problems and provide personalized support.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section3\"\u003e \u003ch2\u003e4.2.3 \u003cem\u003e\u0026ldquo;Teachers\u0026rdquo; with correct answers\u003c/em\u003e\u003c/h2\u003e \u003cp\u003eFrom the students\u0026rsquo; perspective, the boundary between the roles of counselors and teachers is blurred, to such an extent that counselors tend to be primarily identified as teachers:\u003c/p\u003e \u003cp\u003e \u003cem\u003eIn the university environment, I naturally perceive counselors as teachers. Contact persons for psychological service hotlines are often listed in the posts on the official WeChat account of the Center, and these contacts also refer to themselves as teachers. (P01)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eWhen students perceive that the counselor\u0026rsquo;s role as a teacher is significantly more prominent than their role as a counselor, they first recognize the traditional authority of a teacher (as one student described it: \u0026ldquo;A teacher is there to discipline students.\u0026rdquo; P02) rather than the professional authority of a counselor. One student\u0026rsquo;s statement powerfully illustrates the distinction between these two:\u003c/p\u003e \u003cp\u003e \u003cem\u003eThe people you talk to are not just counselors, but teachers. Their professional instinct makes them only offer correct answers while ignoring your emotions, and that\u0026rsquo;s not what I want. What I desire more is the acceptance, understanding, and support from counselors. (P08)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eStudents regard counselors as \u0026ldquo;directive authority figures\u0026rdquo; [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. They tend to perceive that the counselors provide more of an authority-based lecture on right and wrong, rather than empathy-based advice from the perspective of a professional counselor.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003e4.3 Cautious peer support\u003c/h2\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003e4.3.1 \u003cem\u003eHigh-visibility social evaluation pressure\u003c/em\u003e\u003c/h2\u003e \u003cp\u003eTo enhance the accessibility and utilization rate of counseling services, the university has located its MHECC in an office building, which serves as a central area that is easily accessible to students. While this \u0026ldquo;proximity-based service\u0026rdquo; layout effectively meets students\u0026rsquo; need for convenience, it also brings them unease because they anticipate being identified due to the high visibility of the area. As one student explained:\u003c/p\u003e \u003cp\u003e \u003cem\u003eI won't go to the Center. There are people everywhere around it. I don't want to be seen and mistaken for being judged as \u0026ldquo;mentally ill\u0026rdquo;, and leave others with a negative impression. (P06)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eIn a university environment, there is frequent interaction among peer groups, and the MHECC is located in a crowded area. The intersection of these two factors creates a structural problem that leads students to naturally overestimate the likelihood of being encountered by acquaintances when they access mental health services. This can easily lead them to anticipate the negative labeling of \u0026ldquo;being judged as \u0026lsquo;mentally ill\u0026rsquo;\u0026rdquo;. Such labeling could undermine students\u0026rsquo; impression management among their peers and ultimately lead to unfair treatment or gossip in their interpersonal interactions. The high visibility of counseling resulting from the MHECC\u0026rsquo;s central location is amplified in students\u0026rsquo; perceptions into a social evaluation threat. Therefore, once students perceive that the MHECC affords a risk of being seen by acquaintances, they will develop concerns about being noticed and identified, triggering psychological anxiety. These concerns even extend to potential acquaintances they may meet in the future. As one student noted:\u003c/p\u003e \u003cp\u003e \u003cem\u003eEven if we don\u0026rsquo;t know each other now, there\u0026rsquo;s no guarantee we won\u0026rsquo;t meet someday. They might remember seeing you in that place, and that would be really awkward. (P07)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eConsequently, to maintain their positive personal image, they choose to forgo seeking counseling at the university:\u003c/p\u003e \u003cp\u003e \u003cem\u003eI would rather go to a hospital for help if I have problems than visit the Center. Because it\u0026rsquo;s located right in the university\u0026rsquo;s office building. As long as you go there, you can easily be recognized by classmates or teachers, which is really embarrassing. (P05)\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section3\"\u003e \u003ch2\u003e4.3.2 \u003cem\u003eUnbiased yet unapproachable peer support\u003c/em\u003e\u003c/h2\u003e \u003cp\u003eIn a campus environment with dense, acquaintance-based social interactions, students strive to maintain an ideal self-image because they have a deep-seated fear of being categorized as \u0026ldquo;sensitive individuals\u0026rdquo;. When asked about what the most serious consequence of the MHECC\u0026rsquo;s high visibility might be, some students responded as follows:\u003c/p\u003e \u003cp\u003e\u003cem\u003e It is generally believed that there are more highly sensitive people who seek counseling, as they care more about what others say and get hurt easily. So I\u0026rsquo;m worried that if people see me going for counseling, they will also regard me as a highly sensitive person and treat me with excessive caution. It\u0026rsquo;s not exactly discrimination, but they will definitely keep their distance. (P04)\u003c/em\u003e\u003c/p\u003e \u003cp\u003eSimilarly, another student also expressed a similar view:\u003c/p\u003e \u003cp\u003e \u003cem\u003eIf they see you seeking counseling, they won\u0026rsquo;t discriminate against you, but they won\u0026rsquo;t get close to you either. From then on, we can only be classmates, not friends. This kind of relationship is really hard to accept\u003c/em\u003e. \u003cem\u003e(P02)\u003c/em\u003e\u003c/p\u003e \u003cp\u003eOn the one hand, the respondents clearly stated their belief that even if their classmates found out that they were seeking psychological help, they would not be discriminated against for it. Some even argued that \u0026ldquo;classmates who can be aware of their own emotions and take the initiative to seek counseling are very courageous\u0026rdquo; (P03). This indicates that the respondents\u0026rsquo; campus environment has developed a relatively friendly atmosphere of support, and that they themselves hold an open and inclusive attitude toward seeking psychological help. On the other hand, however, the respondents expressed worry that once others became aware that they were seeking counseling, those people would start treating them \u0026ldquo;with excessive caution\u0026rdquo;. This would restrict their originally natural interactions to the level of superficial \u0026ldquo;classmate\u0026rdquo; relationships, making it difficult for them to advance to the stronger bond of \u0026ldquo;friendship\u0026rdquo;. Consequently, their need for emotional connection in the private sphere would not be satisfied. While there is no explicit discrimination in such cases, individuals may nonetheless encounter implicit exclusion through social distancing and thereby lose the possibility of developing deeper relationships and accessing effective peer support.\u003c/p\u003e \u003cp\u003eBy voicing concerns about peer support, the respondents indicate that they do not yet regard seeking counseling as a normal practice of self-care. This perception not only shapes their anticipation of the attitudes of others toward them, but also directly reflects their own attitudes toward others:\u003c/p\u003e \u003cp\u003e \u003cem\u003eIf I knew a classmate was seeking counseling, I\u0026rsquo;d still be very cautious about interacting with them. I\u0026rsquo;m terrified that what I say or do might leave me with responsibilities I never could have anticipated. Putting myself in their shoes, I also worry that others would treat me the same way. (P08)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eAll the respondents reported having experienced emotional distress in the past year. One possible explanation for why they perceive classmates who seek help through counseling as being vulnerable and thus adopt a \u0026ldquo;cautious\u0026rdquo; approach toward them is that, although they themselves have also encountered emotional distress, they were able to resolve those issues through non-counseling channels. This experience made them more likely to establish a cognitive association between seeking counseling and vulnerability, leading them to tend to adopt a strategy of actively distancing themselves from classmates who seek counseling because they want to avoid potential social risks, lest they fall into conflicts or become forced into assuming responsibilities. This also indicates that although few students openly endorse stigmatization, far more may implicitly subscribe to it [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Based on their own experiences, respondents form an attributional pattern and, by \u0026ldquo;putting themselves in others\u0026rsquo; shoes\u0026rdquo;, infer that others hold the same evaluative logic. Consequently, when they perceive that counseling on campus is likely to expose their help-seeking behavior, they tend to proactively avoid counseling because they believe such exposure will threaten the group relationships and peer support they value.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"5. Discussion","content":"\u003cp\u003ePrior studies on the behavior of college students who experience mental health distress but do not actively seek help have mostly analyzed this phenomenon from a single dimension, focusing either on structural barriers or on attitudinal barriers. Even the attribution of low perceived need is expressed as the subjective attitude of individuals who do not feel the need for help. In essence, these studies place MHECCs and help-seekers in a binary oppositional analytical framework and ignore the interactive relationship between the two parties.\u003c/p\u003e \u003cp\u003eThis paper transcends this traditional, binary research paradigm by addressing the prior interactions between individuals and the MHECC, including negative experiences of filling out psychological scales, criticizing counselors\u0026rsquo; qualifications, and examining the location of the MHECC. From the perspective of perceived affordances, this study focuses on the fact that individuals\u0026rsquo; perception of the affordances of the MHECC is based on their own past experiences and cultural conventions, because the degree of an affordance exists relative to a particular user [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWhen discussing the affordances of artifacts, the relational properties of affordances mean that we must focus not only on \u0026ldquo;how\u0026rdquo; affordances work, but also on \u0026ldquo;under what circumstances\u0026rdquo; and \u0026ldquo;for whom\u0026rdquo; they work [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Having relatively high cultural capital, the students at the key university hold a positive attitude toward caring for their own mental health. They not only proactively choose to participate in open elective courses related to emotion regulation, but also show full respect and understanding to classmates who seek professional counseling. However, despite the continuous improvement in their acceptance of counseling, their negative perceived affordances of MHECC have become barriers for them to seek professional on-campus help. In essence, these barriers constitute the non-monetary costs that students have to consider when seeking counseling [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn particular, college students embedded in China\u0026rsquo;s collectivist culture highly value others\u0026rsquo; attitudes toward them and their relationships with others, and this becomes a key issue when deciding whether to seek counseling [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. They assume that \u0026ldquo;group connections are the best guarantee for an individual\u0026rsquo;s wellbeing\u0026rdquo; [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. The benefit of meeting their personal mental health needs should exceed the costs incurred by the damage to their group connections, as the latter can further harm their own mental health. Social isolation is significantly associated with adverse mental health conditions such as depression and has been proven to be an important risk factor for emotional disorders [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Therefore, Chinese people who adhere to the traditional value of collectivism are less likely to seek mental health treatment [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. This is also why matters related to counseling are generally not discussed publicly in China. Most respondents in this study reported relying on hearsay to make decisions about whether to seek counseling. However, in the campus environment, what is most often passed on by word-of-mouth tends to be negative information. This makes it difficult for news of positive cases of successful counseling to spread, further confirming the negative perceived affordance of those who are reluctant to seek help proactively, and thus it shapes these respondents\u0026rsquo; sense of alienation toward the MHECC.\u003c/p\u003e \u003cp\u003eIn terms of mental health care, placing one-sided hope in self-relief may lead to more serious crises, and thus seeking professional services should be one of the coping methods chosen by young people [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Understanding how college students perceive the affordances of their universities\u0026rsquo; MHECCs is crucial for encouraging them to seek help. Affordances stem not only from the objective attributes of the environment but also from the users\u0026rsquo; subjective expectations and beliefs. Even if these subjective perceptions are inconsistent with the objective facts, they still become part of the affordances, thereby influencing users\u0026rsquo; cognition and usage of things [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Whether individuals\u0026rsquo; perception of the affordances of an MHECC is positive or not determines whether they will seek help from it. It is evident that the characteristics of a Center do not absolutely determine outcomes; instead, these characteristics may give rise to a range of potential consequences due to individual differences and varying contexts [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. This implies that even if key universities provide very good counseling facilities and counselors, students who perceive their affordances as being poorly designed will still not use them. Therefore, when most students report having at least some hesitation about seeking treatment for emotional problems, the treatment gap among college students cannot be fully eliminated simply by increasing access to treatment [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTherefore, efforts should be made to optimize the perceived affordances of MHECCs based on universities\u0026rsquo; campus environments, combined with the unique experiences and culture of college students. Notably, students with high cultural capital often are concerned that the counseling services offered by educational institutions pose potential threats to their own long-term educational plans and career goals. Thus, it is particularly important to convey to them the long-term benefits of early intervention and provide positive initial experiences, as this will shape their future decisions to seek help [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Students\u0026rsquo; initial experiences do not start with the official beginning of counseling; any affordances they perceive before entering counseling are included in the experience, such as surveillant services, counseling without empathy, and cautious peer support under the high visibility of the Center. Therefore, if MHECCs can be perceived by users as having positive affordances upon initial contact, that will promote help-seeking behaviors. Moreover, in counseling, perceived benefits are known to have a greater impact on help-seeking behaviors than perceived barriers [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePerceptual benefit information that clearly indicates the affordances of the counseling center should be designed explicitly to enhance usability. Usable designs have information specifying affordances that account for users\u0026rsquo; cultural conventions and level of expertise [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Good designers are responsible for enabling the accurate perception of MHECCs\u0026rsquo; affordances through effective design decisions, ensuring that the perceived affordances align as closely as possible with their real affordances [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. MHECCs at key universities are well-positioned to provide quality counseling facilities and counselors. The perceptual benefit information of these affordances should be clearly designed based on various attributes of college students, such as their experiences, knowledge, and cultural backgrounds, so as to enhance the Centers\u0026rsquo; usability.\u003c/p\u003e \u003cp\u003e \u003cb\u003eStudy limitations\u003c/b\u003e \u003c/p\u003e \u003cp\u003eOur study was conducted at a key university in China, which affects the transferability of the final research results to other universities [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e], especially non-key universities. Given that this study\u0026rsquo;s research involves sensitive topics related to emotional distress and mental health, trust-based face-to-face interviews were used, as they enabled timely follow-up questions on meaningful topics, enriched the experiential data, and deepened the research questions. However, the number of recruited participants was relatively limited. The composition of the current sample may not fully capture all the potential heterogeneity of the research phenomenon. For instance, the perspectives of potential participants who were unwilling to undergo face-to-face interviews due to a lack of trust in the researchers have not been represented in this study. This limitation is expected to be addressed in subsequent research by adopting recruitment strategies such as online anonymous platforms.\u003c/p\u003e"},{"header":"6. Conclusions","content":"\u003cp\u003eSome students at the key university, constrained by their own experiences and cultural backgrounds, hold negative perceived affordances toward the Center. Even if these perceived affordances are inconsistent with the real affordances, they still mean that these students do not take the initiative to seek professional help there. To enhance the usability of the Center, the perceived information regarding the Center\u0026rsquo;s affordances should be optimized based on college students\u0026rsquo; experiences and cultural backgrounds.\u003c/p\u003e \u003cp\u003eCollege students are the first to assess their own mental health. If they can perceive the positive affordances of MHECCs, they will take the initiative to seek help, and this will enable the early detection and timely intervention into their mental health problems. Timely intervention and support bring well-being to both individuals and society as a whole. The findings of this study can not only provide important references for Chinese universities to comprehensively promote students\u0026rsquo; mental well-being in the new era, based on the educational philosophy of \u0026ldquo;Health First\u0026rdquo;, but also offer a new analytical perspective and practical insights for optimizing and improving mental health service systems in universities worldwide.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eMHECC Mental health education and counseling center\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003e \u003cstrong\u003e \u003cb\u003eEthics approval and consent to participate\u003c/b\u003e \u003c/strong\u003e \u003cp\u003e This study was conducted in accordance with the ethical principles of the Declaration of Helsinki. Ethical approval was obtained from the Institutional Ethics Committee of the Clinical Study of the First Hospital of Lanzhou University (Ethics Approval Number: LDYYLL2024-311).\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eCompeting interests\u003c/strong\u003e \u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eNo funding was received for conducting this study.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eXiaofang Jin: conceptualization, methodology, study design, investigation and analysis, writing original draft. Furong Lian: methodology and investigation. All authors have reviewed and approved the submission of the manuscript for publication.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe would like to express our sincere gratitude to all participants for their generous contributions, which made this study possible.\u003c/p\u003e\u003ch2\u003eData availability\u003c/h2\u003e \u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eEisenberg D, Golberstein E, Hunt JB. Mental health and academic success in college. B E J Economic Anal Policy. 2009;9(1). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.2202/1935-1682.2191\u003c/span\u003e\u003cspan address=\"10.2202/1935-1682.2191\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIshii T, Tachikawa H, Shiratori Y, Hori T, Aiba M, Kuga K, Arai T. 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High Educ. 2025;90:1273\u0026ndash;90. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s10734-024-01376-x\u003c/span\u003e\u003cspan address=\"10.1007/s10734-024-01376-x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-psychology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"psyo","sideBox":"Learn more about [BMC Psychology](http://bmcpsychology.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Psychology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Perceived affordance, MHECC, Key university, China, Qualitative","lastPublishedDoi":"10.21203/rs.3.rs-8648425/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8648425/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe students from key universities face a higher risk of depression and anxiety than those from non-key universities. However, the utilization rate of on-campus counseling services remains very low. Working from the theory of perceived affordances, this study investigates the reasons why some college students with emotional distress at a Chinese key university avoid using the provided on-campus psychological counseling services.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis study employed Braun and Clarke's reflexive thematic analysis method to code and extract themes from the texts obtained through in-depth interviews. It was conducted at a key Chinese university, where 13 participants were recruited using purposive sampling and took part in interviews lasting between 30 minutes and two hours.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe study revealed that perceived affordances of the campus mental health education and counseling center (MHECC) among this group of college students exhibited three characteristics: surveillant services, counseling without empathy, and cautious peer support.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eAlthough these negative perceived affordances of the MHECC may be inconsistent with its real affordances, they led this group of college students to make a decision to refuse help-seeking without accessing the counseling services. To enhance the usability of the MHECC, the perceived information regarding the Center\u0026rsquo;s affordances should be optimized based on college students\u0026rsquo; experiences and cultural backgrounds.\u003c/p\u003e","manuscriptTitle":"It may be helpful, but not for me: A qualitative study of the perceived affordances of a mental health education and counseling center among students at a key university in China","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-20 12:46:12","doi":"10.21203/rs.3.rs-8648425/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2026-02-18T15:03:02+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-01-27T15:33:56+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-22T01:40:19+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-22T01:39:05+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Psychology","date":"2026-01-20T10:32:37+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-psychology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"psyo","sideBox":"Learn more about [BMC Psychology](http://bmcpsychology.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Psychology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f660ddc7-0242-45ae-a461-090f6c4a3f33","owner":[],"postedDate":"February 20th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-18T02:54:23+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-20 12:46:12","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8648425","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8648425","identity":"rs-8648425","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}