In a rural Ethiopian setting, people with mental health conditions and their caregivers face various forms of stigma, often linked to cultural beliefs about the causes of mental illness, overt symptoms, and impairments that hinder daily participation. Interviews with service users, caregivers, health providers, and administrators revealed that social exclusion is a dominant experience. Key strategies to mitigate stigma include social contact, sharing lived experiences, and training healthcare providers. The study highlights the importance of understanding the local context in designing interventions, emphasizing the need for integrated stigma reduction efforts alongside expanding access to mental healthcare services.