The State Bar of California has about 225,000 members. Richard Carlton has run the lawyer-assistance program for the state bar in San Francisco for the past 13 years. In those years, he has seen about a half-dozen suicides by lawyers participating in the program. Many other suicides were committed by attorneys who sought no help through the bar association.

Attorneys in the program suffer from depression, alcoholism and drug addiction, as well as post-traumatic stress syndrome, not necessarily linked to practicing law. “Most cases of PTSD that we have encountered come from earlier life experiences — verbal or physical abuse as a child, domestic violence, with recurring nightmares” or other symptoms, he said.

Carlton describes one attorney who had been a police officer before studying law.

“He had PTSD from that experience,” he said.

“The two most common disorders brought to our attention are substance abuse and depression,” said Carlton, whose program serves about 500 lawyers a year, with roughly 150 active at any given time. About half the participants come because they are compelled or encouraged to do so by the State Bar Court in relation to disciplinary hearings. Some attorneys facing discipline attend prophylactically.

In February, the American Bar Association released fresh findings from a joint study with the Hazelden Betty Ford Foundation that reveal widespread mental-health problems among lawyers, especially young practitioners. The study, which surveyed some 15,000 lawyers in 19 states, was published in the Journal of Addiction Medicine.

• Based on volume and frequency of alcohol consumed, more than a third of practicing attorneys are problem drinkers.

• 28 percent struggle with depression.

• 19 percent have symptoms of anxiety.

“Attorney impairment poses risks to the struggling individuals themselves and to our communities, government, economy and society,” said Patrick Krill, an attorney who led the study for Hazelden. "The stakes are too high for inaction.”

The study showed that attorneys experience alcohol-abuse disorders at far higher rates than other professionals including doctors, and more significant mental-health distress.

“This new research demonstrates how the pressures felt by many lawyers manifest in health risks,” said Paulette Brown, president of the American Bar Association, noting that lawyer-assistance programs need to “address the mental-health risks and needs of lawyers.”

“We don’t know how much of that is a function of the experience of being a lawyer,” Carlton said about the problems he sees, or whether the law profession attracts individuals who are predisposed to such disorders.

Lawyers often present a veneer of “always being in control,” said Carlton, who has a master’s degree in public health. “To ask for help or admit that you are no longer able to manage aspects of your practice or your life is a big challenge for a lot of legal professionals.” Lawyers fear loss of confidentiality, that others may find out, the study found.

Attorneys in deep funk may avoid help.

“They ‘man up’ or ‘chin up’ and take it,” Carlton said of the pressure. “They’re unwilling to admit to anybody around them just how difficult it is. Folks who talk about it are the ones less likely to go and act on it. It’s unlikely you would find many people who actually commit suicide who didn’t have depression. They were clinically depressed. Lawyers are often the last ones to go get help. It all feels so overwhelming that they don’t think there’s anything that can be done.”

Carlton’s advice to attorneys who feel overwhelmed: Get help.

“In most cases, those individuals are candidates for medication,” he said, which can be “effective in lightening the cloud,” but may take two or three weeks to show results. Therapy also can make a difference.

Some pressures relate to the business aspects of law. It has become harder since the Great Recession “to have a successful, thriving legal practice,” Carlton said. The legal market has changed, and “there just isn’t as much demand” for legal services, “especially solo practitioners and small firms. I find it very sad — we have a lot of people in our program who are in their sixties, early seventies, really should be retiring. They never saved enough to make it possible. They thought the gravy train was always going to be there. They’re not able to bring it in in the way they used to, and they have no safety net.”

Carlton also sees a surge in help-seeking among young attorneys in their first 10 years out of law school, struggling to make a living and pay off law-school-loan debt that might reach $200,000. Mitchell, a partner in a mid-sized law firm, likely had no such financial pressures.