To address those risks, there’s a move to understand them better. At the University of Montana, Patty O’Brien, a clinical-psychology Ph.D. candidate who worked as a wildland firefighter for a decade, is studying connections between behavioral and physical health in wildland firefighters, and trying to identify patterns of risk. There’s been a fair amount of data on the mental-health risks of structure firefighters, which has often led to change in policy and practices, she says. But research on wildland firefighters is rare.

O’Brien’s dissertation is about Type D personalities, which are prone to experiencing and holding back negative emotions, and the health risks associated with that personality type, particularly among wildland firefighters. An anonymous, online study she’s conducting will ask firefighters about mental-health conditions, including depression, anxiety, and PTSD, as well as related behaviors including sleep, diet, physical activity, tobacco use, and alcohol use.

She says it will be one of the first studies looking at the interplay of those behaviors across a national cross section of wildland firefighters, and that the results might point to high-risk groups: “People are successful in fire because they’re able to focus and suppress emotions, but the flip side of that is that they’re carrying around a lot of intensity.”

O’Brien’s study is part of a growing push to address suicide from multiple directions. Back in 2001, St. Clair was running the Western Great Basin Coordination Center in Nevada when she started getting requests from fire crews for help talking about suicide. There was no precedent, so she and her team started offering classes about the importance of mental health, and trying to connect crews with counselors who both understood the specific risks associated with wildland firefighting and were located in the remote places those firefighters were based.

“We were operating under the radar. At that time the stigma was just huge,” she says. They realized they couldn’t force people to open up, so they started slowly trying to break down the emotional suppression and stoicism they encountered. Like the idea you shouldn’t ask people how they felt, or that you should, as St. Clair says, “rub some dirt so it doesn’t hurt” on any kind of problem. They needed to do it in a way that fit within the firefighting culture. “One time we had a counselor come out and meet us. He was 350 pounds, packing an oxygen tank, and he was trying to talk to these hot shots about how fitness was good for their mental health. He had no credibility,” St. Clair says.

Their approach spread through word of mouth, and more fire crews, even ones run by historically salty older guys, started asking for training. “We knew we were doing good work, because almost everybody who had an issue would come back the next year,” she says. In 2013, the program became an official part of training for the agencies that fight wildfire, because there was such a demand.