Firefighters are repeatedly exposed to potentially traumatic events and occupational stressors (i.e. physical strain, shift work that results in disrupted sleep schedules), thus they experience an increased prevalence rate for a variety of psychological disorders and suicidality. Firefighter culture is unique and those firefighters who endorse mental health concerns and treatment barriers vary by subpopulation (volunteer, career, wildland) and geographical factors (rural vs. urban). Mental health providers must understand the complexity and nuances of the firefighter vocational experience to effectively work with this subpopulation. Extant literature suggests that anticipating negative outcomes from treatment, stigma, and structural barriers inhibit treatment engagement. These treatment engagement factors likely interact at various time points and influence firefighter mental health outcomes. Practice implications highlight how these barriers can be addressed via peer support, informal support, telehealth approaches (e.g., digital storytelling), work-recovery strategies, mindfulness, and critical incident stress management. Future implications suggest that firefighters would benefit from updated clinical practice guidelines specific to this subpopulation to provide optimal care. The emergent research in this area allows for a more advanced understanding of firefighter mental health, highlights research gaps, and appropriate training of culturally competent mental health providers that incorporates diversity factors. The objective of this article is to (a) describe firefighters’ mental health prevalence rates, (b) discuss specific help-seeking and treatment engagement strategies, and (c) review practice implications and research recommendations to enhance cultural competency for mental health providers with the aim of increasing utilization of firefighter-specific behavioral health services.