The tipping point could come from anywhere. It could be the woman who has set fire to herself and asks the firefighter who is first to the scene, "Am I still pretty?" It could be cleaning blood and tissue off a train. It could be trying to resuscitate a man, whose wife is dead beside him, and having him die in your arms.

For Country Fire Authority firefighter Travis Harris, that point – where the trauma of being a first-responder became dangerous for his mental health – was having to flee a fire on Black Saturday, only to discover later that someone had died just metres away.

"What happened if we had have been 10 seconds earlier or pushed ourselves a bit harder to get in there? I felt so bad that somebody lost their life and I was so close."

That experience in 2009, which followed a run of attending fatalities, triggered post-traumatic stress disorder, marital problems and finally, last October, the decision to take his own life. Fortunately Harris's wife Bronwyn intervened. Her action saved his life.

"She grabbed me and wouldn't let me leave. I cried all night; she held me all night," he said.

A visit to the GP set Harris towards recovery, and after four months of intensive counselling he feels like a changed man, though still has ups and downs. "It was a big step but as soon as you take that first step it's a big relief; you know there's people caring about you. It was the weight off my shoulders, asking for help."

Tragically Harris' experience is becoming more, rather than less, common in emergency services: the Victorian fire service is experiencing a mental health crisis, with a dramatic spike in the number of firefighters taking their own lives. Between 2000 and 2012, five firefighters took their own life. In the past 14 months, four Metropolitan Fire Brigade officers have died by their own hand: two men from the same station died within a day of one another.

On an annualised basis these deaths represent an 800 per cent increase. (The CFA does not record members' suicides so the increase is likely higher.)

Similarly the rate is rising in Victoria Police: last week alone two officers took their own lives and there have been eight suicides in the past three years, an annualised increase of 450 per cent. Suicide rates for paramedics, too, have been consistently on the rise.

It's not only frontline responders who suffer: last week the Minister for Police and Corrections, Wade Noonan, announced he was taking leave to seek help for dealing with "unspeakable crimes and traumatic events" in his role. He has been applauded for seeking help.

The head of the Police Association, Ron Iddles, said, "While the national [suicide] average has trended down, the alarming thing for emergency services is it's gone in the opposite direction."

He said mental health issues were complex and combined biological, behavioural, social and environmental factors, but there was no doubt that emergency services workers faced more demands and were more accountable than ever.

The chief officer of the Metropolitan Fire Brigade, Peter Rau, initially questioned the figures and didn't comment on the spike, but said many factors could lead to someone feeling suicidal, some of which could be work-related. He said the organisation was undertaking a review of its mental health services, to identify gaps, but that the MFB, like Victoria Police and Ambulance Victoria, offered a range of services including counselling, peer support programs and wellness checks.

He said the conversation around mental health had to change. "It's really easy to talk about someone who's broken their leg or has cancer. When it comes to mental health it's difficult to have that conversation. We need to do more than just give someone a cup that says Are You OK. You need to have a discussion about what's happening at work and outside – in your family life, the kids."

Harris said the perceived need to appear brave could dissuade people from admitting they were struggling. "In the fire brigade you are expected to be a tough person, which is silly. I'm trying to get it out there that this a very normal thing and there's lots of people in the same boat. It's OK to ask for help and put your hand up and say I'm not OK. What we have to process is not normal."

The psychologist who has treated Harris, Diane Williams, said given the number of incidents emergency services workers attend, and their unexpected nature, being traumatised was "not a sign of weakness, it's a sign of what they've been exposed to". The tipping point can vary, from something innocuous to something more disturbing that might resonate with the person's own life.

There was a consensus across the emergency services that the current Work Cover system put unacceptable pressure on vulnerable workers, which diminished their ability to return to work. Harris applied for medical reimbursement but the subsequent Work Cover investigation triggered another bout of feeling suicidal.

"Once the claim went in I was made to feel like the bad person, that I had to prove I wasn't making it up. That really sent me down a bad path. I hadn't even had any time off work; I was still battling through, still turning up."

Iddles said 38 per cent of police mental health claims were accepted, compared with 98 per cent of physical claims. "The insurer says 'I can't see that' and rejects the claim. The member gets bitter and twisted because no one is helping them and they start to blame the job.

"It might take 9-10 months to get accepted and in that period they're not getting any help. If the claims were accepted straight off the bat and they got psychological help straight away I think we'd be better off."

The assistant secretary of the Ambulance Employees Association, Danny Hill, supported this view, saying, "The current system for dealing with Work Cover claims is completely out of touch and misaligned as far as dealing with psychological trauma that emergency services workers face. Completely."

A WorkSafe spokesman said trying to determine the cause of mental health problem was sensitive and complex, and while agreeing that people could be vulnerable to delays in the compensation process, said it could not be rushed. He said early intervention by employers was key to preventing tragedies. WorkSafe was working with employers and the government to address the complexity of mental injury in the workplace, he added. 

Five senior firefighters told The Sunday Age that a long-running industrial dispute has had a detrimental effect on firefighters' mental health; relations between the MFB and CFA and rank-and-file members are close to breaking point and morale is low.

Harris said, "That's definitely putting stress on people, and the uncertainty. It's been going on for so long about what's going to happen – are our jobs safe? It scares people: it's their livelihoods and anybody would be stressed about that."

The deputy director of the Phoenix Centre for Post-Traumatic Mental Health, Dr Andrea Phelps, said, speaking generally, that "organisational and operational factors did have an impact on people's wellbeing, particularly in environments involving cumulative trauma over time.

"The biggest predictor of recovery after a trauma is the support people get. It's more important than any personal characteristic whether or not you get support afterwards. If you're in a work environment in which you feel supported, it's more likely that you're going to be resilient to the effects of trauma than if you're not. We encourage a whole-of-organisation approach to looking after people who are exposed."

Harris said the teamwork inherent in emergency services created opportunities to save lives – by having the difficult conversations.

"We tell each other we're a team, we stick together but sometimes don't feel comfortable telling them what's wrong. That's what I'm trying to fix – we need to change that culture."

For help or information call Suicide Helpline Victoria on 1300 651 251 or Lifeline on 131 114, or visit beyondblue.org.au

- The Age