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Creating Caring Connections by Sending a Handwritten Card

Simple actions can make strong connections and benefit mental health.

Key points

  • A new intervention, Caring Cards, where people with lived experience of mental illness make cards for others, was practical and enjoyable.
  • Sending a Caring Contact to people right after they leave psychiatric hospitalization can improve recovery.
  • Making cards for other people could help you increase your social connection and gratitude while helping others.
Blaire Ehret, PhD, used with permission.
Source: Blaire Ehret, PhD, used with permission.

By guest blogger Blaire Ehret, Ph.D.

Bill, junk mail, bill… card! There is something exceptional about receiving a card in the mail. It breaks up the monotony of our day and lets us know someone is thinking of us. Someone cares. With the power of technology and being thrust into the virtual world during COVID-19, we can connect with others quickly–texting a friend or sending a Tweet takes seconds. Although having these connections readily available at our fingertips is immensely helpful in many ways, an all too real and unintended consequence of these quick connections is that they can feel impersonal, and their benefits often disappear as quickly as they appear. Receiving a handwritten card shows that someone decided you were worth the extra time and effort, and in our busy, fast-paced world, this is hard to come by.

This past year has shown us the importance of being connected. As humans, we are social creatures, and garnering support is the key to surviving and thriving. So, it is unsurprising that connectedness and having a sense of belonging play a large role in our mental health and can even impact the risk for suicide (Van Orden et al., 2010).

Social Connection and Suicide

The Interpersonal Theory of Suicide (IPTS) posits two key social factors associated with suicide risk: thwarted belongingness and perceived burdensomeness. Collectively, these factors are referred to as social disconnectedness (Van Orden et al., 2010). According to the IPTS, thwarted belongingness develops when the need to belong is unmet and comprises loneliness (a sense of inadequate social connections) and the absence of reciprocally caring relationships (lack of caring for another and being cared for by someone).

Perceived burdensomeness arises when individuals perceive themselves to be so profoundly useless that they burden others. The concept of purpose (for example, responsibility to others) is central to perceived burdensomeness. Perceptions of purposelessness are strongly associated with suicide risk, and just as a lack of social connectedness predicts suicidal risk, social connection is a strong protective factor against suicide.

Suicide Prevention Through Caring Contacts

A simple yet genius approach to suicide prevention, developed by Jerome Motto and Alan Bostrom (2001), leverages the importance of fostering feelings of connectedness by sending well wishes to patients following a psychiatric hospitalization through supportive letters written and mailed hospital and/or research staff. This approach, appropriately named, Caring Contacts, has been used and researched across various settings, formats, populations, and nations (Luxton et al., 2020). Although research has demonstrated mixed results for this intervention, its use is generally supported (Luxton et al., 2013).

In recent years, the use of peers (individuals with lived experience of mental health concerns) in mental health services had grown exponentially. Research on the inclusions of peers has shown their involvement can greatly improve patients’ mental health recovery (Resnick & Rosenheck, 2008).

A relatively new approach called Caring Cards, inspired by Caring Contacts and the inclusion of peers in mental health recovery promotes connections between individuals with mental health concerns by creating and distributing one-of-a-kind handmade cards (Ehret et al., 2021). Created with Veterans living with serious mental illness, Caring Cards is an intervention where individuals meet in a weekly group to create cards for unknown peers needing extra support. These cards are then mailed to peers struggling with mental health concerns. A recent pilot study determined that Caring Cards is a practical intervention and enjoyable for the people who make and receive the cards (Ehret et al., 2021).

Although we don’t yet know the impact making and receiving these caring cards has on mental health and suicide risk, this approach hopes to facilitate social connection, helping individuals who are struggling with mental health to feel less burdensome, experience a greater sense of purpose, and feel like they belong. Given Caring Cards’ resemblance to Caring Contacts, it’s likely this new peer-involved approach will also be generally effective for suicide prevention.

The simple act of sending a card can benefit both people.

Caring Cards is likely to benefit other groups of people–not just Veterans with mental health concerns, but anyone looking to feel more connected. In fact, happiness researcher Steve Toepfer examined the impact of writing letters of gratitude on participants’ well-being. Well-being increased for those who wrote the letters, and the more letter writing they did, the more they benefitted. However, for those that did not write letters, their well-being was unchanged.

Intentionally taking the time to spread kindness to someone else gives us a special sense of purpose and meaning, helping us step outside of ourselves and feel closer to others. On the flip side, when that person receives your kindness, a sense of belonging is felt, and a connection is reciprocated. So, the next time you’re feeling disconnected, consider creating (or, if you’re not the creative type, buying) and sending a caring card for someone. I bet this simple act will connect you, brightening your day and theirs.

Dr. Ehret is a licensed clinical psychologist and Suicidologist who specializes in suicide prevention and risk assessment research and providing clinical services to Veterans living with psychosis. She is an Assistant Clinical Professor in the Department of Psychiatry at the University of California, San Diego.

If you are having thoughts of suicide, call the National Suicide Prevention Lifeline at 800-273-8255, or text TALK to 741741 to text with a trained crisis counselor for free, 24/7.


Luxton DD, Smolenski DJ, Reger MA, et al. Caring e-mails for military and Veteran suicide

prevention: A randomized controlled trial. Suicide and life-threatening behavior. 2020;


Luxton, D. D., June, J. D., & Comtois, K. A. (2013). Can postdischarge follow-up contacts prevent suicide and suicidal behavior?. Crisis.

Van Orden KA, Witte TK, Cukrowicz KC, et al. The interpersonal theory of suicide. Psychol review. 2010;117(2):575-600.

Motto, J. A., & Bostrom, A. G. (2001). A randomized controlled trial of postcrisis suicide prevention. Psychiatric services, 52(6), 828-833.

Ehret, B. C., Treichler, E. B., Ehret, P. J., Chalker, S. A., Depp, C. A., & Perivoliotis, D. (2021). Designed and created for a veteran by a veteran: A pilot study of caring cards for suicide prevention. Suicide and Life‐Threatening Behavior.

Toepfer, S. M., Cichy, K., & Peters, P. (2012). Letters of gratitude: Further evidence for author benefits. Journal of Happiness Studies, 13(1), 187-201.

Resnick, SG, Rosenheck, RA. Integrating peer-provided services: a quasi-experimental study of

recovery orientation, confidence, and empowerment. Psychiatric services. 2008;59(11):1307


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