Creative Æffects Towards Destigmatization
Jennifer A. Arrowsmith
School of Health and Human Services, Selkirk College
HSER 281 – Directed Studies Methods
Rhonda Belczyk
May 2023

HSER 281 – Literature Review
Jennifer Arrowsmith – May, 2023

1

INTRODUCTION
There has been an increase in the prevalence of people experiencing homelessness,
especially over the past few years. In Canada, there were more than 235,000 homeless people in
2021, not including the precariously housed or the hidden homeless such as those couch surfing
while awaiting permanent residence (Kalajdzieva, 2022). Statistics from shelters indicate that
people of all sexes and ages, including children, experience homelessness, and that there are
several causes for someone to be without a home that can affect “absolutely anyone”
(Kalajdzieva, 2022). What can be overlooked is that people experiencing homelessness can be
examples of individuals with strengths that could offer positive contributions to their
communities if it weren’t for their impeding struggles to thrive. Stigma prevents this, including
preventing positive relationships between those who aren’t homelessness and those who are, as
well as people experiencing homelessness being unable to access supportive resources. To
address stigma as a barrier requires exploring various approaches in initiatives that have been
effective in reducing stigma that could be applied in future initiatives to address homelessness.
This literature review proposes that creative and artistic tactics and strategies, including
involving people with lived experience of homelessness or mental illness, can and do work to
reduce stigma. Positive collective outcomes in reducing the barriers of oppression caused by
stigma can, therefore, bring more equality and opportunity to humanity, especially for those who
are at risk of or are experiencing homelessness.
EXPERIENCES AND IMPACTS OF STIGMA
The Canadian Charter of Rights and Freedoms indicates that “everyone has the right to
life, liberty, and security,” and “everyone is equal and has the right to equal protection,” yet this
equality isn’t demonstrated in the population of those experiencing homelessness (Justice Law

Website, 2023). Experiencing an unequal, especially lower than others’ distribution of resources
or power, combined with the labelling and separating effects of stigma, causes a loss of an
individual’s status, capacity, power, protection, and liberty. This can create circumstances in an
individual’s life that can cause or exacerbate physical or mental health challenges, as well as
social, financial, material, or spiritual challenges. Any, or a combination of these can be factors
that contribute to the onset or ongoing experience of homelessness.
Though homelessness does not necessarily intersect with mental illness, it can.
Researchers using statistical methods found evidence that affirms that “the prevalence’s of
serious mental disorders (in people experiencing homelessness) were raised compared with
expected rates in the general population” (Fazell, et al., 2008). Furthermore, research specific to
stigma around mental illness is relevant to this discussion because this body of knowledge
correlates to the general body of knowledge around stereotypes, prejudice, and discrimination.
There is established evidence otherwise to support the growing understanding of the
interrelationship between mental and physical illness (Sinjoy, et al., 2019). Regardless, support
for mental illness is only provided 7 per cent of health care dollars, which makes this limited care
additional inequity amidst those who may be experiencing the consequences of poor mental
health amidst their experience of homelessness (Canadian Association of Mental Health, 2023).
Throughout multiple sources of current literature, a common definition of stigma is
provided by Link and Phelan (2001) as “the co-occurrence of labelling, stereotyping, separation,
status loss, and discrimination in a context in which power is exercised.” Stereotypes, prejudices,
and discrimination all relate with stigma. Prejudices, or prejudgments, reflect an evaluation of a
group or individual resulting in negative attitudes towards those identified based on incorrect
beliefs or incomplete information (National Academies of Sciences, Engineering, and Medicine,

2016). These generalizations often function to preserve the position of a dominant group.
Stereotypes offer prejudicial characterization of an entire group, attributing specific
characteristics to group members which impairs from seeing the differences between people
within that group or the positive qualities of its apparent members (National Academies of
Sciences, Engineering, and Medicine, 2016). Examples might include an individual’s perceived
dangerousness or unpredictability due to their group association, or that they are responsible for
their conditions likely due to inherent weakness. Additions to others’ negative perceptions might
also include intersecting judgements around factors such as race, poverty, age, or disability.
Discrimination results in unfair prejudicial behaviours toward an individual based on their group
membership, commonly resulting in endorsed differential treatment, including avoidance and
rejection (Stangl, et al., n.d.). Being discriminated against makes it difficult for individuals to
enjoy his or her human rights equal to others. Collectively, prejudices, stereotypes, and
discrimination represent the attitudes, beliefs, and behaviours of others that negatively impact the
well-being of those who experience stigma.
Someone under the conditions reflected above is likely to feel a mark of discredit or
shame, often due to the negative beliefs and feelings held by others, commonly referred to as
public or social stigma. That which occurrs within and about oneself is referred to as personal
stigma, reflected in an individual’s “lowered self-esteem, decreased self-efficacy, and
psychologically harmful feelings of embarrassment and shame” (National Academies of
Sciences, Engineering, and Medicine, 2016). Whether an individual experiences the negative
social attitudes of others’ or they internalize this as personal stigma, compounding factors from
these create an exclusion from groups and enhances an individual’s feeling of isolation. The
impact of these stereotypes “has an impact on people’s sense of identity and leads to reduced

self-esteem and diminished expectations,” including a negative impact on health, social,
academic, and employment achievements (Mental Health Commission of Canada, 2015). This,
therefore, can lead to an individual being rejected or impaired from their ability to find or follow
through with helpful resources to positively support their social, material, physical, mental,
spiritual, and cultural resources. Research otherwise asserts that negative impacts of stigma can
affect health through a multitude of ways, including bearing on physical and mental health
directly and indirectly through stress responses, as well as invoking risky behaviours such as
substance abuse (Claire, et al., 2016).
In addition to the demoralizing personal effects of internalized stigma, and attitudinal
effects of public stigma, one may also experience behavioural effects of structural stigma. This
occurs when professionals stereotype individuals in search of public services, including
indulging in micro aggressive behaviours, as well as in the restriction of services offered.
Renowned sociology scholar and early thinker on stigma offered that stigma is a powerful means
of social control enforced by marginalizing, excluding, and exercising power over individuals
who display certain traits (Goffman, 2963, referenced in Afolabi, 2018). The Mental Health
Commission of Canada (2015) suggests that “the effects of stigma and discrimination can be
seen in the chronic underfunding of the mental health system, lack of affordable housing, and
income and disability supports that do not always meet people's needs.” Clair, et al. (2016) also
suggest that this unequal distribution of resources includes discriminatory treatment that restricts
access to education and employment, which further adds to the structural stigma that will also
contribute to health disparities. These experiences give cause to clearly consider ways that
stigma can be reduced personally, publicly, and structurally.

It is possible that the more equally distributed resources will help to reduce the overall
national health expenditures based on more positive health outcomes that reducing stigma would
help to afford. Building social bridges of acceptance between those who have and those who
haven’t been marginalized will help to supply people at risk of or experiencing homelessness the
same rights, respect, and entitlements as the broader population. Additionally, addressing stigma
will also help to reduce future spending beyond the nearly four billion dollars that the federal
government has commit over 9 years, beginning in 2019, to a federal program entitled “Reaching
Home.” This program aims to help “the most vulnerable Canadians maintain safe, stable, and
affordable housing and eliminate chronic homelessness across the country” (Infrastructure
Canada, 2022). Supporting the reduction of prejudices, stereotyping, discrimination, and
separations of power that result from personal, social, and structural stigma will thereby support
the reduced need for this societal cost in the future.

APPROACHES TO DESTIGMATIZATION (ANTI-STIGMA)
There have been multiple approaches to what authors of an article in Social Science and
Medicine refer to, and what will continue to be referred to here as “destigmatization” (Claire, et
al., 2016). This resource suggests that “(m)any stigma-reduction interventions aim to change
potential stigmatizers’ beliefs and attitudes, often by seeking to refute stereotypes, shift causal
attributions, and/or diminish feelings of difference” (Claire, et al., 2016). This paper explores
ways to reduce stigma using education/information and protest approaches. It will consider art
interventions such as initiatives involving visual, literary, and performing arts, as well contactbased approaches. Various concepts will be explored that will help to benefit future initiatives
towards destigmatization.

INFORMATIONAL / EDUCATIONAL APPROACHES
The intention behind an informational approach to destigmatizing is for the purpose of
educating. The premise is that factual information will help to correct misinformation and
counter inaccurate stereotypes or myths. These can be presented locally, nationally, or even
globally and can include initiatives such as information leaflets, literacy campaigns in school
programs and community groups, news and radio broadcasts. There is research in the field of
mental health that suggests that changing public stigma in a significant and lasting way through
educational programs alone has mixed evidence of its effectiveness, though it is perhaps more
effective in changing younger people’s attitudes and reducing personal stigma when delivered as
component of cognitive behavioural therapy (National Academies of Sciences, Engineering, and
Medicine, 2016). A meta-analysis of randomized controlled trials to measure the effectiveness of
programs for reducing stigma associated with mental disorders suggests that “null effects were
obtained for the interventions involving an educational component and for those containing only
an educational component” (Griffiths, 2014). Adding to this research suggesting that information
alone has limited efficacy, an Associate Medical Director for Mental Health Services in Glasgow
affirmed in a study replicated 25 years later that informational approaches to destigmatization
had little to no affect (Smith, 2013). In this author’s evaluation of an anti-stigma campaign in
England, the editorial representing “a milestone in international stigma research” proposes the
need for a new approach that would include researchers better understanding “the nature of
events that are reported as stigmatizing,” and “the ebb and flow of population attitudes and
opinions” to better target future educational initiatives (Smith, 2013).

PROTEST APPROACHES
Protest interventions that support destigmatization are typically targeted at public
incidents of discrimination and are often focused on the structural level in the interest of
changing organizational practices and behaviours. The use of protest helps to highlight stigma’s
injustices while confronting the offenders who perpetuate negative attitudes and behaviours,
thereby aiming to suppress stigmatizing attitudes (Moeenrad, et al., 2023). Benefits to this
approach include garnering greater public support, expanding the stakeholder base, and
providing a forum of consensus in visibility.
In a PdD thesis considering “the social impact of large projects on Indigenous Peoples,”
the author provides a comprehensive, though not exhaustive list of over 200 forms of protest that
contribute to information, fundraising, publicity, mobilization, solidarity building, political
pressure, and direct action. Though not specific to homelessness or mental illness, this body of
information is applicable due to its focus on examining protest as a response to infringement on
human rights. It suggests that “(p)rotest is thus a legitimate and necessary way for communities
to seek redress for the issues being ignored by decision makers” (Hanna, et al., 2016). This is
evidenced in a Northeastern city in New York when people experiencing homelessness were able
to improve “provision of resources such as welfare benefits, shelter provision, and housing
assistance,” in spite of having “minimal resources and organizational structure” (Hanna, et al.,
2016). This article goes on to suggest that the disruptive strategies of protest led by “the very
visibly poor” may in some cases be quicker and” more sweeping” (Hanna, et al., 2016). Despite
the potential of its positive impact, the scope of this paper does not allow depth of discussion on
the breadth of this potential approach. What is noteworthy here, however, is the opportunity to

include a range of artistic approaches in protest efforts of destigmatization for benefits that are
mostly related to reducing structural stigma.

ARTISTIC APPROACHES
The limited positive effect of informational approaches to destigmatization invites
incorporating art interventions, including performing, visual, and literary arts, or more
specifically artistic activism. Arts are often employed “as a key component in conversations on
citizenship… but also to instill cohesion within diverse societies” (Wilmer, 2012, and Grundy &
Boudreau, 2014, referenced in Potash, et al., 2018). It’s otherwise been claimed that “community
arts have been effective venues for disrupting stereotypes, promoting empathy, showcasing
diversity, reimagining identities, and initiating dialogue” (Potash, et al., 2018). The Center for
Artistic Activism (C4AA) suggests in a report that there are whole programs in art schools
dedicated to this practice, beginning with the first of its kind in 2007 at Portland State University.
From graduate programs, to university, college, and continuing education courses, classes
examining the intersection of arts, politics, and social activism abound (The Center for Artistic
Activism, 2018). As do over 1000 books on Amazon related to the keyword search of “art and
activism.” C4AA (2018) also identifies entire museum exhibitions in largely populated
destinations devoted around this practice. Museums that hold summits hosted by large
educational institutions and bringing artistic activists from all over the world together are also
documented. Authors suggest that more important than these initiatives “is the attention turned to
the artistic activism by NGO’s and philanthropic funders” (The Center for Artistic Activism,
2018). These individuals and organizations have integrated the arts into their social
programming or made the support of arts and activism a predominant aspect of their mission.

Significant examples were given of those who “work with activists who aspire to create more
like artists, and artists who would like to strategize more like activists” (The Center for Artistic
Activism, 2018). It was suggested in this report that the rational for this increased merger relates
to an impression that strictly sharing information can result in little uptake of applicable
knowledge, and that capturing attention and supporting people while resonating with the way
that they make sense of the world is best done with compelling images and engaging stories. Not
only can various art forms engage our thinking, but it can also impact how we feel. In an article
analyzing the work of artist Mark Rothko, it was suggested that “being moved” by art happens
“as we try to understand, are frustrated, and arrive in a new, abstract space, driven by the artwork
and the emotions it activates,” and that the brain activation during these emotional encounters
implies “that the artwork may prompt us to think about our own lives” (“The Rothko Effect”,
2023). This relates to the ‘affect’ that art has, which according to the Oxford English Dictionary
is to “have an effect on the mind or feelings of (a person); to impress or influence emotionally.”
Art also relates to the ‘effect’ that it can have on a person, which in a definition within the same
dictionary suggests is “to bring about (an event, a result); to accomplish (an intention, a desire).”
To combine both meanings, authors of ‘Assessing the Impact of Artistic Activism’ combine the
two words, resulting in ‘Æffect’, also used throughout this paper, and suggests that activism
corresponds to ‘effect,’ while art corresponds to ‘affect.’ (The Center for Artistic Activism,
2018). Authors of a meta-analysis to determine the effectiveness of arts interventions to reduce
mental-health-related stigma among youth add that “multiple art forms are potentially more
impactful than other art forms in lowering stigma, as a combination of art forms likely aims for
more intense experiences compared to use of a single art form” (Gaiha, 2021). It is suggested
that this is due to these programs having “potential for greater interactivity and longer duration,”

as well as having various opportunities to entice people by providing a range of art experiences
that one could relate with (Gaiha, 2021). The purpose of engaging others with artistic activism is
ultimately to influence positive social change, and the way that it can “communicate(s) ideas,
ideals, and perspectives” makes it well suited to “conform readily to an idealist theory of social
change,” including the way that it can positively influence destigmatization (The Center for
Artistic Activism, 2018).

VISUAL ART BASED APPROACH
Visual art provides an opportunity to depict social circumstance with personal expression,
making it a form of expression that individuals within a stigmatized group can use to
communicate their lived experiences with others. Neuroscience and other technological
developments have investigated positive effects of artistic performance on the brain, and have
found that using art to contribute to social interactions has otherwise been shown in studies to
improve participant’s emotional, physical, social, and intellectual well-being (Owens, 2019).
This suggests that the creation of art offers benefits that could improve an individual’s
experience of personal stigma. Using art to engage a viewer’s empathy would also support public
destigmatization with the understanding that “several researchers have indicated the significance
of empathy in both attitudinal and behavioural change,” and that “interventions that trigger
empathy can lead to pro-social behaviour” (Potash, et al., 2013). These factors make art
beneficial to both artist and viewer in efforts towards destigmatization.
In an example of interest to determine viewers responses to art made by people living
with mental illness, researchers conducted a qualitative study representing 13 client-artists
depicting something in art that they each wanted to share about their life with others. The images

included “depictions of loneliness, symptoms, hopes and coping strategies” (Potash, et al., 2013).
After viewing every art piece, participants were asked to choose one piece of art that resonated
with them, and then engage in relational inquiry and practices mostly through a guided
questionnaire. This data collection determined that “the majority of participants ‘agreed’ or
‘strongly agreed’ that viewing art helped them to understand the experiences of people living
with mental illness” (Potash, et al., 2013). Participant responses indicated emotional and
behavioural empathy, reflections of their own self-orientation in relationship to the artist or
artwork, becoming ‘other-oriented’ in expressed desires to assist, and evoking world-oriented
linguistically expressed responses “that were focused on a general condition or shared humanity”
(Potash, et al., 2013). Authors of this research suggest that findings in these self-, other-, and
world-oriented categories of this research “may demonstrate how art making promotes a
response distinct from one’s normal interactions” related to evoking both empathy and action
(Potash, et al., 2013). This personal to global scope of positive responses, therefore, gives cause
to consider the use of visual art as having a positive Æffect towards efforts of destigmatization.

LITERARY ART BASED APPROACH
Stories have been used throughout history to convey information and educate people.
Narrative storytelling offers a personal point of view and is often used to relay a series of events
that convey someone’s lived experiences. It has been tested to create positive behaviour change,
and to offer health support, resulting in positive effects (Alvarado-Torres, R., et al., 2022). An
example was provided in research whereby several participants were asked to compare two
different sources for obtaining information or support around helping a loved one with a
substance use disorder (SUD): 1. a digital narrative website representing a father’s journey with

his son, and 2. a fictitious state department of health website that offered facts, figures, and
statistics, along with phone numbers to resources. This research resulted in aspects deemed as
important for future narrative storytelling approaches towards destigmatization. It was affirmed
that while the fact-based site was suggested as having importance, the narrative story evoked
feelings of connection and empathy while offering inspiration and meaning, including relevance
to humanity, making it more valuable than fact-based information alone. Participants felt that
message delivery is best provided to participants by neutral third parties that can demonstrate
success in their achievement’s, thereby making their participation more perceivably trustworthy.
Bilateral trust was otherwise noted as important; that the ideal messenger “is someone who can
both trust and be trusted” (Alvarado-Torres, R., et al., 2022). In this SUD specific research, it
was offered that key messages should instill hope and solidarity, and could support the creation
or enhancement of a social network that could support others in their experiential and
educational journeys. In the testimony that stories “give you some kind of common ground to
start a dialogue” it was suggested that “narrative stories could be used as an important starting
point to engage others (in learning about SUD), regardless of where they fall on the spectrum of
readiness” (Alvarado-Torres, R., et al., 2022). Lastly, digitally based narrative stories provide
people who have been stigmatized against an opportunity to remain anonymous in their share,
while also providing anonymity to users seeking the relevant information towards their efforts of
destigmatization. Offering narrative stories online also offers people responsible for
destigmatization an easy point of access to information. Ideally, stories will be told from
different perspectives so that a broad audience can relate to them. Though this study contributed
to the literature to support ways that narrative storytelling can specifically support those
supporting loved ones with an SUD, it wasn’t specifically tested for efficacy. It instead offered

what authors felt was a significant step forward in supporting its target population that could also
be transferrable to populations of people experiencing homelessness or mental illness. Other
research measuring the effects of internet-based storytelling programs on reducing mental illness
stigma concluded that “internet-based storytelling programs with stigma-related content and
interactivity elicited the largest effects in stigma reduction, including reductions in public stigma
and microaggression” (Fong and Mak, 2022). This research combined suggests that literary
approaches to destigmatization offers promising outcomes.

PERFORMANCE ART APPROACH
Like visual and literary art, performing arts lend audiences opportunities to engage with the
stories of artists. Live public theatrical performances created from research, including interview
transcripts, journals, fieldnotes, statistics, and more, used to “investigate a particular facet of the
human condition” are considered “ethnodrama,” or simply put is “dramatizing the data” (Saldaña,
2005). Ethnodrama can be expressed in forms such as “revue, rant, radio drama, poetry,
performance art, story theatre, reader’s theatre, chamber theatre…participation theatre, simulated
lecture, and ritual” (Saldaña, 2011, referenced in Perkins, 2012). This artistic expression
empowers “ordinary individuals to document their lived experience and represent their concerns
to the community and policy makers as reminders of the artists’ presence in society” (Potash, et
al., 2018). Performing arts otherwise offer an opportunity for people to have accessibility to
broader spheres of influence than scholarly activity while still offering opportunity to educate
and inform audiences. Through its use of dialogue to share meaning, and its critical and
reflective lens, performance art, or ethnodrama, empowers audience participants to think

alternately and consider informed decisions towards solving problems by encouraging
interpretation and critique; ingredients necessary for social change.
In an approved thesis submit by Christine Perkins for requirements in her “degree of
Doctor of Education,” she explored “how B.C. public school principals and vice-principals
understand and respond to homophobia in one school district,” and she expressed that “the use of
ethnodrama as a method to analyze, critique, and present data prove(d) most appropriate” in the
way that “new perceptions, new ideas, and new realities will emerge” (Perkins, 2012). Commonly
referring to performance art as engaging in “a play” may relate this to the way that “the
imagination and curiousity embodied in play permits creative activity to remedy apathy” (Greene,
1995, referenced in Potash, et al., 2018). Furthermore, play has been recognized to “facilitate
dialogue, experimentation, community building, and direct democracy” (Shepard, 2005, referenced
in (Potash, et al., 2018). With these associations, performance art can be considered an applicable
and beneficial art form that “enables audiences to approach the arts with curiousity as a bases for
considering the intersection of the artists’ and the viewers’ worlds,” thereby positively Æffecting
destigmatization (Potash, et al., 2018).
CONTACT-BASED APPROACHES
Delivering a contact-based approach to destigmatization means having target audiences
hear personal stories from, and (or) involving direct interactions with members of a stigmatized
group. This provides realness and relatability offered by someone sharing their lived experiences.
To not otherwise have contact with these members allows for a space in which feelings of
discomfort, distrust, and fear can emerge based on prevailing negative stereotypes. Three key
mechanisms to reducing stigma through direct contact include supporting knowledge about the
outgroup, reducing anxiety about intergroup contact, and empathy/perspective taking (Pettigrew

and Tropp, 2008, referenced in Tippin & Maranzan, 2022). Providing contact offers
opportunities for the public to hear the challenges and stories of success of people experiencing
homelessness or mental illness. It also affords possibilities for positive connections and
interaction between groups that aim to overcome the otherwise interpersonal divide (National
Academies of Sciences, Engineering, and Medicine, 2016). Evidence in mixed-methods research
published in the National Academy of Sciences suggests that outcomes of contact-based
programs “demonstrates robust effects in pre-post studies and at follow up,” and that the efficacy
“is greater than that of education programs alone,” although “one-time contact is not as effective
as repeated contact” (National Academies of Sciences, Engineering, and Medicine, 2016).
Barriers to in-person contact can also be explored with the possibilities of video-based, filmed,
and web-based contacts, and have been found to have positive results (Fong & Mak, 2022).
Other research suggested that positive changes of attitude and intended behaviour were “twice
those of education alone,” and benefits were otherwise identified when people with lived
experience of mental illness related their own life experience to support and personalize factual
information as part of a contact-based intervention (National Academies of Sciences,
Engineering, and Medicine, 2016). It was otherwise affirmed in a data synthesis published in the
Canadian Journal of Psychiatry that suggested “programs that included multiple forms or points
of social contact had significantly larger score improvements than programs that did not include
this program ingredient,” and included recommendations that multiple points of social contact
should occur for best effect (Knaak et al., 2014). This was affirmed in a systematic review of
anti-stigma programs aimed at college students, that determined that although in-person contact
had twice the effect size, video contact was also effective in reducing social distance
(Yamaguchi at al, 2013, Corrigan et al., 2012, referenced in National Academies of Sciences,

Engineering, and Medicine, 2016). Knaak et al. (2014) also determined that “the quality of social
contact is more important than the length of that contact.” Combined, this information suggests
that there is significant value in contact-based approaches to destigmatization, and that
interventions that included additional approaches, delivered multiple times or in differing
locations would be most positively Æffective.
The Mental Health Commission of Canada worked with various organizations who had
conducted anti-stigma interventions targeted to health care providers, to evaluate program
outcomes that support recovery from mental illness, delivered using a contact-based educational
format. Outcomes in this research resulted in a 6-ingredient model of key program elements that
were viewed as “particularly important” in improving previously stigmatizing attitudes and
behaviours in contact-based approaches to destigmatization. Including all six of the ingredients
was reported to result in “significantly better performance than those that included fewer
ingredients,” including that the program should: “include social contact in the form of a personal
testimony from a trained speaker who has lived experience of mental illness; employ multiple
forms or points of social contact (for example, a presentation from a live speaker and a video
presentation, multiple first voice speakers, multiple points of social contact between program
participants, and people with lived experience of mental illness); focus on behaviour change by
teaching skills that help health (and service) care providers know what to say and what to do;
engage in myth-busting; use an enthusiastic facilitator or instructor who models a personcentered approach (that is, a person-first perspective as opposed to a pathology-first perspective)
to set the tone and guide program messaging; and should emphasize and demonstrate recovery as
a key part of its messaging” (Knaak, et al., 2014). This successful delivery model, therefore,
offers evidenced support, including key ingredients towards future destigmatization efforts.

PEER SUPPORT APPROACHES
It has been asserted that contact-based approaches that have been designed to reduce
public stigma have also “been shown to benefit self-stigma by creating a sense of empowerment
and boosting self-esteem,” thus making this approach more dually beneficial than other
approaches (Corrigan et al., 2013, retrieved from National Academies of Sciences, Engineering,
and Medicine, 2016). A related approach that has played an essential role in combatting selfstigma which has been helpful in the field of mental illness and is very likely transferrable to
homelessness, is incorporating peer support. Showing benefits since their arrival in the 1970’s,
peer support programs and services offer practical, social, and emotional support, and are
claimed to be “critical in helping individuals to overcome the debilitating forces of self-stigma,”
including research that suggests that people who use peer support programs “are more likely to
use other behavioural health services of all kinds” (National Academies of Sciences,
Engineering, and Medicine, 2016). This approach has otherwise been considered essential in
circumstances where individuals of a stigmatized group had to be psychologically ready to
present themselves in public effectively, including engaging with questions and open discussions
with professionals or members of the general public (National Academies of Sciences,
Engineering, and Medicine, 2016). Peer support, therefore, offers individuals who have been
stigmatized against an opportunity to reduce their experiences of personal stigma, thereby
providing a positive Æffect towards their engaging in support services, and society in general.

LIMITATIONS
When offering approaches to destigmatization, it is worth considering some inherent
difficulties. Firstly, giving voice to those who are stigmatized against will help to inspire and
inform relevant and desired destigmatization outcomes. The Kelowna Homelessness Research
Initiative (2021) provides researchers and practitioners with a framework that offers significant
ways to embed people with lived and living experience of homelessness authentic opportunities
to integrate into a co-research or co-construction process. It is otherwise proclaimed that “the
peer reviewed literature in this area, although growing, remains meager and incommensurate
with the hidden burden caused by stigma,” indicating that more evaluation of approaches
towards destigmatization is required (Stuart, 2016). There is often little resource to provide
formal research to produce evidence in support of the positive effect that various approaches can
offer destigmatization. One positive example of how to approach this is provided in a report
relating to Canada’s Opening Minds anti-stigma initiative. This offers a good example of
developing formal partnerships for efficacy research, as this program did with five universities
across Canada amidst a large network of program service providers, resulting in clear outcomes
of “improved social acceptance of people with a mental illness across different target groups and
sectors” (Stuart, 2016). Not only does a partnership like this provide important insights, but it
also provides an opportunity for future exchange between policy makers, providers, and
researchers. The report from the Opening Minds program research further affirmed that “big
media campaigns are not effective at changing attitudes,” and that more than one session is
required to boost previous learning. (Mental Health Commission of Canada, 2013). Furthermore,
evaluations will provide more robust outcomes if they commit to future follow up beyond shortterm periods (Griffiths, et al., 2018). Lastly, identifying active ingredients for valid positive

outcomes in a program are claimed to be lacking. It has been suggested that effective testing of
principles and procedures of successful destigmatizing programs, using rigorous methods, will
be most meaningful to future programs and has been identified as a priority for the benefits of
public health (Stuart, 2008, referenced in Stuart, 2016). In summary, future destigmatization
initiatives should include people experiencing stigma when developing evaluation procedures;
creative strategies in partnering with others to conduct evaluations and amplify benefits;
evaluation periods should be extensive; and it’s important to consider individual objectives in
evaluation procedures. Each of these considerations will improve the body of research that
identifies effective approaches towards destigmatization.

CONCLUSIONS
It is suggested that “stigma and discrimination toward individuals experiencing
homelessness and mental disorders remain pervasive across societies” and “there is an urgent
need to increase focus on strategies and policies to reduce stigma and discrimination in this
population” (Mejia-Lancheros, et al., 2020). With the increased prevalence of homelessness in
Canada, examining personal, public, and structural stigma causes consideration about how
prejudices, stereotypes, and discrimination can negatively Æffect (influence both emotions and
action) one’s human rights, sense of equality, self-efficacy, and well-being. Reducing stigma can
be achieved with various approaches. Literature suggests that informational or educational
approaches to destigmatization have limited effect. Protest approaches can have positive Æffect
but are mostly beneficial when specifically addressing structural stigma. Meanwhile, creative
and artistic tactics and strategies, including involving people with lived experience of
homelessness or mental illness, can and do work to reduce stigma. These have been shown to be

more Æffective in the way that they offer creative ways to evoke empathy and citizen
engagement that can lead towards societal change and cohesion. Visual art, for example, can
have a positive influence in countering personal stigma, while also evoking empathy in viewers
that can influence a reduction in public stigma and enhance prosocial behaviour. In addition to its
ability to showcase breadth of experiences, literary art offers a potentially anonymous
opportunity to provide common ground from which dialogue can occur. This approach has been
shown to evoke feelings of empathy and connection, while motivating inspiration and meaning
in others. Performance art, or ethnodrama, represents stories based on true life experiences and
data. It provides shared meaning through a critical and reflective lens, while providing audience
members opportunities to interpret and critique aspects necessary for social change. Research
literature suggests that contact-based based interventions are the best approach for
destigmatization. This offers direct interactions with stigmatized individuals that help to diminish
discomfort, distress, and fear while evoking empathy towards the out-group’s challenges and
successes. This helps to overcome the interpersonal divide between the in and out groups.
Research shows that having a trained speaker with lived experience of stigma, providing multiple
points of social contact, teaching skills to effectively respond to out-group members, engaging in
myth-busting, having a facilitator demonstrate a person-centered approach, and emphasizing
stories of success and recovery all provide successful outcomes towards contact-based
approaches of destigmatization. Peer support has also been shown to be effective in reducing the
negative Æffect’s of personal stigma. In addition to offering practical, social, and emotional
support, peer support inspires individuals to engage in other behavioural health support services.
Lastly, it is recommended that the development of destigmatization approaches include voices of
those experiencing stigma to help inform and evaluate intended outcomes. Given the often-

limited resources to measure outcomes, it is recommended that initiative leaders find creative
solutions to ensure both long- and short-term evaluations of their approaches to reducing stigma.
Contributing to this body of research will help to amplify the ways that approaches to
destigmatization can help to illustrate the reality of those whose lives have been affected by
stigma, open audience members from their defenses, create conversations, generate empathy and
affect, encourage participation, and evoke action towards social change. Collectively,
considering these aspects towards destigmatization will benefit and affirm the human rights and
self-efficacy of those facing homelessness or mental illness, thereby reducing collective
expenditures and enhancing the equality of all.

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