Barriers to mental health help-seeking among firefighters: a scoping review

Firefighters are routinely exposed to occupational trauma that is associated with high rates of occupational stress injury. Yet many are unable or reluctant to seek mental health supports. This scoping review aimed to systematically identify, map, and categorize the existing evidence on these barriers to inform policy, practice, and future research. Using PRISMA-ScR guidelines, a scoping review was performed. Searches were conducted in multiple databases and grey literature sources in 2026. Twenty-eight studies met the inclusion criteria and were charted using a structured data extraction form by two independent reviewers. Qualitative thematic synthesis was performed. Four barriers were identified: stigma (self-stigma, public stigma), organizational (lack of leadership support, confidentiality concerns), structural (limited access to services, cost, scheduling), and psychological (self-reliance, emotional suppression). Stigma was the most prevalent barrier, reported in over 92.3% of studies. Differences shared many concerns but career firefighters were more concerned about career impacts and volunteers were facing more pronounced financial and access-related obstacles. Firefighters encounter multiple interconnected barriers to seeking mental health support, including individual beliefs, occupational culture, and systemic limitations. A multi-level ecological approach is need to remediate the lack of help that firefighters currently experience in dealing with occupational stress.