Objective: This study aimed to determine patterns of help-seeking among first responders for conditions such as post-traumatic stress disorder (PTSD) and psychological distress. Method: Data from Answering the Call, the Australian national survey of the mental health and wellbeing of police and emergency services, was analysed to determine mental health help-seeking associations, as well as to measure patterns of service use. This encompassed 14,868 employees across the ambulance, fire and rescue, police, and state emergency services sectors. Results: Over half of employees needing help for a mental health issue neither sought nor received help. First responders with severe mental distress who delayed seeking help reported that they needed a lot more help than they received. Poor help-seeking behaviour and experiences were found to be associated with high levels of PTSD and psychological distress, low levels of mental health literacy, and career concerns. No significant differences were found between the sectors with all employees exhibiting high levels of poor help-seeking behaviour. For organisation-sourced services and programmes, usage levels and perceptions of usefulness were consistently low. Conclusions: Findings support the importance of early help-seeking amongst first responders with emerging mental health conditions. All sectors exhibited sub-optimal help-seeking behaviour and experiences. The problems go beyond the organisational structures, policies and programmes of any individual sector and are likely to be systemic. While all organisations provide mental health and wellbeing programmes and services, they are either not well taken-up, or are not considered sufficiently useful by the people they are designed to help. KEY POINTS What is already known about this topic: First responders are known to be at high risk of developing mental health conditions. The rate of PTSD in Australian first responders is twice that in the general population. Early and appropriate treatment is essential in preventing mental health conditions from worsening or becoming chronic. What this study adds: This study shows consistently high levels of sub-optimal help-seeking behaviour and experiences among Australian emergency services employees across all sectors. Over half of emergency services employees needing help for a mental health issue neither sought nor received help. Usage and perceived usefulness of organisational mental health and wellbeing programs/services are very low.