Traditional views

According to Chen, the psychologist, little psychological counseling is available to firefighters, despite a growing need for the service. Moreover, many firefighters hold a traditional view that it is better to work out one's problems alone.

"This is especially true if they have failed to save the life of someone they believe could have been saved. Then, they feel a sense of guilt and think it's their fault," she said. "If negative emotions are not dealt with correctly, a mental shadow can form."

For many firefighters, psychological counseling takes the form of talking with colleagues, mentors and senior officers.

"Chatting or drinking with comrades can reduce a lot of the pressure firefighters feel," said Zhao Yu, one of the deputy directors at the Wangjing Fire Bureau.

According to Zhao, a number of local psychological clinics often send counselors to speak with firefighters and relieve long-term pressures, and the bureau provides musical events to encourage team building and raise morale.

However, the lack of professional post-traumatic psychological support is a growing concern, despite efforts to improve the situation.

The problem partly stems from the fact that such support has a relatively short history in China.

The 2008 Wenchuan earthquake was a milestone in post-traumatic psychological support in China, according to Liu Zhengkui, an associate professor with the Institute of Psychology at the Chinese Academy of Sciences, who specializes in disaster psychology and trauma treatment.

Before the quake－which claimed more than 69,000 lives and left nearly 18,000 people missing in the southwestern province of Sichuan－no psychologists in China specialized in post-traumatic assistance, he said.

Liu added that inappropriate counseling provided by untrained volunteers exacerbated the problems experienced by survivors and also firefighters, who were on call 24 hours a day and needed extra counseling because of pressure of work.

"The situation resulted in firefighters from other parts of China, who had not experienced the quake but were working on rescue missions, also developing PTSD," Liu said.

National standard

In 2013, the Armed Police Academy of China formulated a national standard for psychologists who work with firefighters. The regulation sets the goals and principles of counseling and emphasizes the importance of establishing personal records for all firefighters.

Although applied nationally, the standard can be tailored to meet local requirements. For example, the fire authorities in Zhejiang province have invited psychologists to design a series of tests to assess the mental health of firefighters, and any deemed to be at risk have one-on-one counseling.

Liu said it is essential that a national system of psychological intervention is established to help firefighters cope with the stresses they encounter in their working lives and safeguard their mental health.

"Right now, I am not optimistic about their psychological equilibrium," he said.