In "The Final Call," "Fault Lines" explores the hidden epidemic of suicide among U.S. firefighters—and asks why more isn’t being done to address depression and PTSD. The film airs on Sunday, Feb. 21, at 9 p.m. Eastern time/6 p.m. Pacific on Al Jazeera America. | Click here to find Al Jazeera in your area. In the early evening of January 22, 2014, Captain Mike Mauser, a 49-year-old firefighter-paramedic in Clarksville, Tennessee, drove his green Subaru SUV to a local cemetery. His body was found a day later by a passerby. It was hanging from a tree. “It was quite shocking,” said Mauser’s daughter, Lauren Ferguson. “He held inside whatever was bothering him.” Ferguson, an EMT and trained disaster manager, believes that her father was suffering from emotional trauma triggered by what he experienced over the course of his 33-year career. “What got him in the end was what none of us could see,” Ferguson told “Fault Lines.” Mauser’s death is not an isolated incident. Firefighters in the United States are three times more likely to die by suicide than in line of duty, according to the National Fallen Firefighters Foundation (NFFF), an organization chartered by Congress to honor and provide support to the families of firefighters killed on the job.

The same year Mauser killed himself, roughly 109 firefighters and paramedics took their own lives, according to one estimate. That’s an average of two deaths per week. In 2015, a record 113 firefighters and paramedics killed themselves. The numbers, however, could be much higher because there is no official database tracking suicide by firefighters and paramedics. Very few fire departments report these incidents, and very few first responders ask for help—a product of a culture that stigmatizes showing any type of weakness, whether physical or mental. “Suicide among our brothers and sisters is real,” said Captain Jeff Dill, a retired firefighter and founder of the nonprofit Firefighter Behavioral Health Alliance. According to data he’s collected, the number of firefighters and paramedics taking their own lives has grown nearly every year since 2011.

Witnesses to human tragedy

Firefighters and paramedics routinely witness traumatic events. Beyond fires, they are called to the scenes of mass shootings, homicides, suicides, road accidents, and instances of child abuse, among myriad other incidents. Such job-related experiences led retired firefighter-paramedic Tim Casey to start posting videos online, sharing his memories of the job and reaching out to other first responders dealing with trauma and depression.

A photo of Tim Casey, a retired firefighter from Colorado Springs, Colorado, who shared tales of his depression in a series of YouTube videos. He took his own life in the summer of 2015. Singeli Agnew for Al Jazeera America In one of his posts to YouTube, the 31-year veteran of the Colorado Springs Fire Department recounted his inability to save a toddler: “A mother had backed over, accidentally, the head of her baby toddler and squished its brain out. And we showed up on the fire engine, and she handed me a baby with its brain coming out—and the baby was still breathing—and said, “Save my baby.” And I didn’t save the baby. I mean, obviously, it died.” Because of calls like these, Casey started reliving harrowing incidents he'd seen in his dreams. “Witnessing that kind of activity day in and day out starts wearing on you,” he said in one of his videos. Casey was eventually diagnosed with post-traumatic stress disorder (PTSD). He turned to alcohol to cope with his suffering. The 57-year-old ultimately killed himself on July 31 last year in his Colorado Springs home, inhaling fumes from his car as its engine ran in his closed garage. Prior to his death, Casey had attempted suicide at least twice in the past. “Fault Lines” spoke to Casey for hours on the phone and was scheduled to interview him in August. He died three weeks before the meeting.

Overcoming a macho culture

While Casey was willing to talk about his job-related trauma, depression and suicidal thoughts, that’s not standard practice in the fire service, as “Fault Lines” heard repeatedly in interviews with more than two dozen firefighters and paramedics across the country. The predominant culture in the fire industry dictates that mental health issues are a sign of weakness. “We suffer what I call ‘cultural brainwashing,’” said Jeff Dill. The firefighter-turned counselor travels across the U.S and Canada to conduct workshops for firefighters on issues related to mental health and suicide prevention. For many in the fire service, he said, “You put this uniform on, this is how you’re supposed to act: strong, brave, offer help, don’t ever ask for help.” That pervasive machismo led Mike Mauser to conceal his own mental health issues, his friends and former colleagues said.

Joe Stambush, who works at the Bellevue-Dayton Fire House in northern Kentucky, where he first met Mauser more than 20 years ago, couldn’t hide his bewilderment at his friend’s suicide. “Never in a million years would I have imagined someone like Mike doing something like that,” he said. After 58 years in the fire service, the 70-year-old Stambush, who is also a Vietnam veteran now mostly provides training to other firefighters. He said Mauser could have come to him if he needed to talk about anything, but he understands that a lot of his peers prefer to keep personal matters to themselves. Experts say having firefighters talk to each other, as opposed to therapists, could be the key to addressing mental health issues and suicide in the fire service. Judith Bock, a psychologist at the University of Colorado Colorado Springs, supervises the Colorado Springs Fire Department’s 12-year-old Peer Support Program. The initiative relies on actual firefighters becoming counselors for their colleagues because, she said, “They know their coworkers so well.” According to Bock, peer supporters undergo an intensive week-long training that enables them to detect early warning signs and symptoms of mental illness. They can then suggest confidential treatments, if needed, or refer the individuals to psychologists for further evaluation. (Because Tim Casey retired from the department in 2008, he was no longer eligible to participate in the Peer Support Program.)