For years, a former emergency worker could not drive through the town where she was pushed out of her job without shaking uncontrollably.
Responding to murders, sexual assaults and drug-related incidents in a regional area, the intense workload and "blokey" culture had finally worn her down after two decades.
Sam, who asked her full name and job title not be used in order to speak openly, left her career as a first responder with severe mental distress in 2023.
Years earlier, she had worked up the courage to tell her boss she wasn't coping, only to be given extra work.
When she pushed back, Sam felt she was punished for insubordination.
"That was the straw that broke the camel's back," she told AAP.
There was no way to access long-term confidential mental health care through her employer, as her boss needed to sign off on the paperwork, she said.
Experts fear unique workplace pressures and limited mental health support outside the cities may exacerbate labour shortages, with research showing regional workers face complex psychological risks.
Workers' compensation data released by Allianz Insurance on Tuesday showed regional employees were disproportionately affected by workplace mental health issues.
Mental injury claims were 19 per cent of all claims in the regions, compared to 13 per cent in metro areas.
Stress was the leading driver of claims among regional employees, followed by bullying or harassment and workplace violence.
Poor workplace culture underpinned many of those issues, while emergency staff, teachers and retail employees were copping increased abuse, Allianz's mental health strategy manager Brianna Cattanach said.
That likely reflected a broad decline in wellbeing across the community," Ms Cattanach said.
"People are increasingly dealing with challenges in the workplace that are ... confronting and harmful and are being driven through interactions with those outside of the workplace," she said.
More than 700,000 regional workers were considering leaving their job within the next year, according to a YouGov survey commissioned by the insurer.
Nearly a quarter of regional respondents said their mental health was the worst it had been in their working lives, while almost 20 per cent said there was no workplace support available.
Employers needed to actively engage local support services, while also recognising that personal pressures affected workers, Ms Cattanach said.
"Workplaces really need to consider this evolving challenge we're seeing across our communities and how it might be interacting with your workers," she said.
A separate study showed rural emergency workers experienced more complex mental health risks than their city counterparts.
They faced added pressures of isolation, misogyny and expectations of stoicism, with a risk they could "leave in droves" without support, the University of New England research found in September.
Sam, who is still recovering, said a culture of stoicism initially hid the building pressures.
"People tend to soldier on. But it gets to the point where the wheels fall off," she said.
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