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More than 17 percent of the 112,042 people who have enrolled nationwide in the federal government’s World Trade Center Health Program—which provides physical and mental healthcare to those who were at and near the site during and after the attacks—were certified as having a mental health condition as a result of 9/11. This is according to data as of June 30 from the Centers for Disease Control and Prevention, which noted that hundreds of thousands of others who could have physical or psychological conditions, such as post-traumatic stress disorder, haven’t yet signed up for the program.

That’s partly because of the perceived stigma of seeking assistance, says , a clinical psychologist and director of mental health at the at NYU Grossman School of Medicine. Many first responders who are still police officers, emergency medicine personnel, and firefighters today feel that admitting to mental health issues might put their status at their job in jeopardy.

“There are a set of values that are part of what you might call responder culture that privilege things like mental toughness and dependability, and an ability to control one’s emotions,” Dr. Haugen says. “Being able to express and identify and communicate feelings, in particular to someone who isn’t a co-worker, is often seen as a weakness, a moral failing, a source of shame, and these folks oftentimes can feel like it’s even a betrayal of their brothers or their co-workers: ‘I am weak and someone who can’t be depended upon by my colleagues in difficult situations.’”

The World Trade Center Health Program at NYU Langone Health is one of seven centers established by the 9/11 Health and Compensation Act to provide monitoring, screening, treatment, and support services to responders, survivors, and residents in the wake of 9/11.

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