David West barely slept the night his older brother, William Ballantyne West Jr., called him from his D.C. apartment, sounding worried.

His brother had earned the nickname “Iron Will” for the tenacity he showed when faced with challenges. He had rock-climbed, gone on a religious mission to Italy and competed in overnight relay races. But during that call earlier this year, Will talked about how his problems felt too big to solve: He was not getting the training he needed to prepare him to practice medicine. He was not getting enough time to sleep or recharge after long shifts. Happiness, he felt, would elude him always. David considered asking someone to check on his brother, but during their next two phone calls, Will eased his concerns. He laughed and seemed lighter. After a call in late February, David hung up feeling relieved. Days later, Will was gone. He died by suicide at the age of 33.

There is no way to know for certain what led Will to end his life. But what is known, interviews with Will’s family, George Washington residents and national experts show, is that despite a growing acceptance nationwide of the benefits of mental health care, barriers persist in residency programs that keep doctors from seeking help during a time when many need it.