Keeping a journal is great, except for one thing: If you’re really struggling, the narrator of those entries — you — could be your own worst enemy.

This insight led then 14-year-old Diana Chao to start what would eventually become Letters to Strangers (L2S), the 2024 MDRT Annual Meeting charity partner, which has helped more than half a million people on six continents in the last decade. The organization’s slogan is “Mental health made personal,” and to understand the simultaneously private and public nature of that statement, you have to start with writing a letter.

Chao had survived a suicide attempt after being diagnosed as bipolar and living below the poverty line in Southern California for four years. Her parents, who spoke no English, treated her as less-than for being a girl, and she was bullied as “this Asian kid in a very, very white town and school.”

So, Chao, who previously grew up in a very poor area of China, wrote a letter to an imaginary person. Someone who would be exactly who she needed in that moment. It was a bold effort driven both by Chao’s yearning for support and a feeling of responsibility to her brother, who is four years younger and, in Chao’s words, “found me on the edge of death” when she attempted suicide.

“I started thinking that it is very, very sucky that all of this happened, and I feel horrible, but I feel better thinking that someone out there cares enough to listen to me and maybe cares about me,” she said. “I felt like I could finally find a path toward hope and therefore healing, and if writing letters to strangers could help me, maybe it can help others as well.”

Beyond pizza budgets

Chao founded L2S as a club during her sophomore year of high school. She enticed friends to come to the meetings, using a very small budget to buy pizza. Club members would share their vulnerabilities and struggles and support others enduring the same challenges by writing anonymous letters, which were rotated among meeting attendees for reading and discussion. The pizza budget ran out, but people kept coming.

Then a girl from a neighboring town wanted to join by starting a club at her high school, leading to the creation of L2S’ first chapter. Chao taught her how to replicate what she was already doing: encouraging others to write letters to strangers and facilitate meetings where people could turn their inner struggles into a supportive community. Letters were shared with other chapters. More towns got on board, then states, then countries. There is even a free, online platform where individuals unaffiliated with the network can exchange letters. L2S now operates in 70 countries and each year serves 35,000 people, the majority of whom are people of color who are women or nonbinary.

“One thing that worked in my favor, sadly, was I heard so many stories from people who told me they wanted to do this because seeing me was the first time they saw someone who looked like them, or had a growing-up story similar to theirs, and was speaking up about mental illness and not hating herself for it,” said Chao, who is currently finishing her MBA program at the University of Oxford. “I definitely had a lot of self-hatred, but I guess it didn’t come across that way, and this movement wouldn’t be possible if I wasn’t honest about how my entire identity impacted my mental health negatively and positively.”

You may be wondering, why write to strangers? The point, Chao says, is partly to remove the pressure to give someone top-tier advice when many people don’t know how to comfort each other all the time. It also creates double-sided anonymity, ensuring that the writer can’t be judged by skin color, gender or their history, so their story is the only thing that matters.

“It’s purely the story of my life that I am telling, and I have control over that story,” she said. “Writing letters to strangers reminds me that I have a voice worth using, a story worth telling, and all of that leading to a life worth living.”

At the 2024 MDRT Annual Meeting, participants in the MDRT Foundation service project will create a care package that includes writing supplies, books, T-shirts and more that L2S can distribute among its chapters. Anyone unable to attend can learn how to donate or get involved at letterstostrangers.org. Engagement options include submitting a letter, registering a club in your community or introducing L2S’ free materials if your local schools don’t have a mental health plan in place.

L2S is driven by both the idea of and the actual unfolding of a team effort. The organization’s core staff consists of about a dozen employees (all younger than 26, in line with the under-30 population being served) who work with more than 130 chapters. In addition to anonymously exchanged letters and peer-led discussions, the organization also provides a guidebook and teacher’s handbook that is used as a curriculum around the world, including teaching 10,000 high schoolers in Nepal, where L2S has a partnership with the government. L2S also offers grassroots advocacy and a variety of services, including a hotline operated for the entire African continent (managed from L2S’ Liberia office and funded through that country’s national budget) as well as mobile pop-up clinics, counseling programs and more.

Empowering through struggle

Clearly, this is a global issue, and it’s worth reiterating that Chao — who spent time as a crisis counselor for the National Suicide Prevention Lifeline — has seen both how hard people can have it as well as the connection between mental and physical health. Her own mental health trauma sparked psychosomatic symptoms that caused her to lose her eyesight for half of her high school experience, at one point even suffering a 110-degree fever and going on life support. She was 6 years old the first time her family threw her out of the house, and she survived by scavenging food from dumpsters while living in the bottom level of a supermarket parking garage.

After her dad passed away, her brother said it was like they were grieving two different people. Yet before he died, Chao’s father apologized to her, a sign to Chao that intergenerational trauma can progress to a healthier place.

“It was something that would have been beyond impossible for me to imagine as a child,” she said. “But it also proves that when I started walking this path, even though it was very difficult and my family was embarrassed by it at first, we all want and need to heal. And when we open the door first and invite other people in, what happens after is often beyond our wildest imaginations.”