For a young person struggling with mental health, what kind of difference would it make to know they aren’t alone? To know that someone else at school feels the same loneliness or heartache or has the same problems at home?
In Diana Chao’s case, it turned out to be lifesaving. At 14 years old, she put all of her pain into letters addressed to no one in particular — pouring out the feelings that led her to attempt to end her own life. When she re-read the letters shortly after, she was struck by an epiphany.
“I realized I was trying very hard to be the listener and empathetic stranger that I wanted in my life,” Chao, now 23, says. “That led me to get on my healing journey.”
As a high school student, she founded the first chapter of Letters to Strangers, a nonprofit, youth-led organization where students shared anonymous letters about their mental health struggles and found camaraderie and support.
Ten years later, the organization has grown to over 100 student chapters in 20 countries, including new chapters this year in Kenya and Rwanda. Depending on their interests, Chao says, the student-led chapters might exchange letters based on a theme, focus on education around mental health, or participate in advocacy for mental health resources at their schools.
Some letters offer a pep talk to students who feel pressure to have life figured out: “There will be obstacles thrown at us, and maybe we don’t get to slay the fire breathing dragon or kiss prince charming, but frankly we are pretty damn awesome.”
Others are more philosophical, like this writer who shares their thoughts about loneliness: “How many times do we say hello in a lifetime? How many times do we pretend not to see the other person? To avoid awkward conversations? Let’s slow down a bit.”
In a time where concern is growing over the mental health of young people — whether from the isolation of the pandemic or pressure to perform happiness on social media — Chao finds that the desire among teens to connect with their peers has held steady since her own high school days.
“One thing across our generations is people tend to feel like, ‘Parents don’t understand me’, and you sort of have inherent trust in someone your own age,” Chao says.
Chao was 13 years old when she was diagnosed with bipolar disorder and uveitis, a condition that causes periodic blindness.
Getting mental health treatment wasn’t an option, she says. Chao’s family immigrated to California from China when she was 9 years old, and they faced financial and language barriers to finding her care.
“I was trying to figure out a way to heal in a health care system that my family could not afford, and was linguistically unable to participate in,” she says.
After starting the first chapter of Letters to Strangers at 14, Chao says it grew by word-of-mouth when students from other schools heard about the club and wanted to start their own chapters.
The reactions to the concept were mixed, Chao recalls. After a classmate died by suicide, the Letters to Strangers group at her school wrote anonymous letters of support and dropped them in students’ lockers. Chao says she cried after seeing one student tear up the letter left for him. But another student thanked her.
“I did end up getting a call from someone, and to this day I don’t know who it is, but they said that the letter they got saved their life,” she recalls.
While Letters to Strangers’ mission is to help end the stigma around mental health, Chao says she was deeply ashamed of her own diagnosis and struggles when she was in high school. She didn’t mention the club on her college applications, fearing she would be seen as a “liability” by whomever read them.
“I told a handful of people about my diagnosis and hid Letters to Strangers as an education club,” Chao says of the time.
She decided to speak openly about her mental health struggles for the first time in 2018 in an extremely public way — during a TEDx event for teen innovators. Her talk has been viewed online over 10,000 times. That’s when the organization saw a huge spike in interest.
“I got this unbelievable response, especially from people who said they saw someone who wasn’t white — an immigrant like them, under the poverty line like them — recognizing and talking about mental health without seemingly being that ashamed of it,” Chao says, “and realizing that maybe there is some merit to caring about this stuff.”
Making an Impact
Today, Chao is a climate scientist by day and executive director of Letters to Strangers by night. In some ways, the organization has grown right alongside her.
It offers scholarships for both students who plan to pursue a career in mental health and for students who need help paying for mental health treatment. It has published a mental health guidebook for young people and a separate curriculum for teachers.
Dan Kanceljak, the Letters to Strangers chief outreach director, says the peer-to-peer networks provided by each chapter not only break down financial barriers that members might face in getting mental health support but also aim to chip away at the stigma around asking for help.
“We were born to connect, and the more we can acknowledge our own humanity, the more we acknowledge the humanity of everyone else,” he says. “It’s OK to be a work in progress as much as anyone else.”
A key difference that has emerged since the organization was founded is that members of Gen Z, and children even younger, who struggle with body image issues now have to contend with standards set by social media, like the use of image-perfecting photo filters. There’s been a “trend-ification” of mental health issues on social media, too, Chao says, where some people view mental health disorders more as interesting personality traits instead of conditions that can be challenging to live with.
“I had a high school student come up to me after a talk and say, ‘You must feel so lucky to have bipolar disorder,’” Chao says. “Because depression and anxiety — everyone has them. Now, it’s not ‘cool’ anymore.”
While some adults may assume that modern teens are more open and knowledgeable about mental health and how to get help, Chao says that’s a misconception.
“If you think about it, where you have your understanding of mental health, most likely it comes from the media you’ve ingested — from movies or articles — but not from a psychologist,” she says. “It’s the same with Gen Z and younger folks; that doesn’t mean exposure is in terms of correct information or nuanced information.”