One in three Australian FIFO workers experiences high or very high psychological distress—three times the rate of the general population—yet routine mining medicals contain no standardised mental health screening. Behind the high-vis vests and six-figure salaries lies a workforce trapped by ‘golden handcuffs’: lifestyle inflation and mounting debt that make escape from mentally damaging rosters feel impossible. Workers describe leading “two separate lives,” switching between aggressive site personas and family man roles, with re-entry anxiety peaking in the first 24 hours home—often before anyone thinks to ask how they're really doing. Compounding the crisis, up to 60% may have undiagnosed sleep disorders that mimic depression, while rational fear of losing fitness-for-work certification keeps workers silent; those who fear disclosure are 20 times more likely to be experiencing high distress. For GPs, this population demands a strategic shift: asking about transition days rather than running standard depression screens, using STOP-BANG to reframe fatigue as a “safety issue” rather than a mental health problem, and recognising that relationship breakdown—not workplace accidents—is the primary trigger for suicide in this cohort.