A qualitative collective case study design was used to explore how people with lived experience (PWLE) of mental health conditions are involved in stigma reduction interventions in China, Ethiopia, India, and Nepal. The study found that involving PWLE in these initiatives is a relatively new concept in low- and middle-income countries (LMICs). Key challenges include identifying suitable individuals for participation and sustaining their involvement due to concerns about disclosure. Professional support, consistent engagement, and respect for confidentiality emerged as essential for maintaining their participation. Recommendations emphasize the need to consider cultural norms and privacy issues to promote effective and respectful integration of PWLE in social contact-based stigma reduction efforts.