SAN ANTONIO – On Sept. 11, Americans honor the brave police and firefighters who sacrificed their lives for the greater good.
Now, 18 years later, first responders across the nation who continue to care for their communities are losing their lives at staggering rates.
However, it's not on the job. It is by suicide.
"Today is maybe a time to remind them why they do their jobs because these people truly were heroes. I think also it probably brings the potential to bring up bad memories," said Dr. Melissa Graham, who worked as the psychologist for San Antonio police for 10 years and now works with San Antonio firefighters.
She said the trauma of an event like 9/11 translates today in other ways when police respond to mass shootings like Sutherland Springs, or firefighters battle the flames at Ingram Square Mall that killed one of their own.
But it's also the everyday trauma they see.
"Any child deaths that they've ever responded to, especially if they have kids. It just gets worse. Then, mass casualties, really horrific car wrecks. Those leave a mark. Those are things that, you've seen them you can't take it away," Graham said.
Those experiences can trigger Post Traumatic Stress, and researchers say it's contributing to rising suicide rates.
"It's pretty comparable with both police and fire. They're both about four times more likely to commit suicide than to die in the line of duty and that should never happen," Graham said.
She acknowledges it's difficult to understand, seeing how the culture is changing.
"Twenty or 30 years ago people weren't going to get help because if I show any weakness or perceived weakness I'm not going to be able to function or I'm not a good firefighter or police officer. We know now that's not the case," she said.
She said San Antonio is ahead of the curve.
"It's fewer here but one's too many," Graham said. "I just got back from a conference and compared to some other departments, San Antonio is really progressive because we do actually pay attention to mental health."
She said many areas don't have the resources San Antonio and other big cities have, so people don't talk about or address mental health
The resources allow first responders to be proactive about mental health. When crews are sent to traumatic situations, the dispatcher sends an alert to the peer support team that then meets the crew at the station after the event.
Graham is even working to strengthen that peer support team so no critical events fall through the cracks and everyone who needs service, gets it.
"We also are creating resiliency programs so what we're trying to do is teach people up front and from cadet classes. We just started with a cadet class, how to recognize symptoms of stress so that they never get to the point where they burn out, can't do the job, or don't want to do the job," she explained.
She said she's proud that San Antonio officials made mental health a top priority, caring for the heroes who spend every day caring for their community.