| Individual level of stigma: person who experiences stigma |
- Enacted stigma (i.e., unfair treatment) (e.g., psychological stress)
- Internalized stigma (e.g., low self-esteem and feelings of shame)
- Anticipated stigma (e.g., does not access support)
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- Group-based supports to change stigmatizing beliefs, improve coping skills, support empowerment, and build social support
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- Reduction in internalized stigma
- Improved psychological well-being and mental health
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| Interpersonal (person-to-person) level of stigma: family, friends, social and work networks, healthcare and service providers |
- Language (e.g., using derogatory terms or dehumanizing labels; refusing to use preferred name and/or pronoun)
- Intrusive attention and questions
- Hate crimes and assault
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- Education interventions to target myths and lack of knowledge. Include components that encourage examining personal values, biases, and beliefs
- Contact interventions, including sharing personal stories, to target stigmatizing beliefs and attitudes
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- Better understanding of the facts about stigmatized health conditions
- Increased understanding of diverse perspectives and experiences of stigma
- Growing social acceptance
- Reduction in stereotyping
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| Institutional level of stigma: health system organizations, medical and health training schools, community sector organizations, social service organizations |
- Being made to feel "less than" (e.g., having to wait longer than others to be seen; lack of empathy from staff)
- Physical environment is not inclusive (e.g., washrooms are single-sex; undersized chairs in public areas)
- Institutional policies that cause harm (e.g., unnecessary drug tests; low investment of services)
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- Ongoing and continued training targeting conscious and implicit bias
- Implementation of cultural safety and cultural humility models
- Safe and inclusive physical environments
- Workforce diversity initiatives
- Institutional collaboration with community; policies that support and fund meaningful engagement with people with lived experience of stigma
- Implement trauma- and violence-informed care models
- Accountability and monitoring frameworks that include stigma reduction indicators
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- Institutional environment is inclusive, welcoming and diverse
- Organizations are able to meet the needs of all populations
- Reduction in stigmatizing beliefs and attitudes among staff
- Improved patient/client ratings of care, satisfaction and trust
- Patient/client outcomes improve
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| Population level of stigma: mass media, policies, and law |
- Widely held stereotypes
- Negative portrayals in film and television (e.g., people with mental illness portrayed as violent)
- Discriminatory policies and laws
- Inadequate legal protections, or lack of enforcement of these protections
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- Mass media campaigns to challenge stereotypes and prejudice
- Guidelines to reduce stigma in media reports
- Protective laws and policies
- Addressing discrimination within existing laws and policies
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- Reduction in stigmatizing beliefs, attitudes, and intended behaviour among the public
- Reduction in discrimination practices
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