Primary Findings

Despite offering a number of important health and education services, the institution did not have a specific system for integrating residents into their communities or supporting their deinstitutionalization. In the institution, the needs of residents appeared to be met, and some residents reported enjoying their time at the centre, but interviews highlighted the residents’ isolation from the community and inability to live with autonomy. As one resident put it, “I am free to do what I want, but I can’t go out for a walk.” Their exclusion was likely compounded by paternalistic attitudes demonstrated by some staff members, who appeared to believe residents were not capable of making important decisions about their own lives.

The institution affirmed that institutionalization often stems from a lack of other options for care. Some residents stated that they had nowhere else to go. Interviews with parents and residents revealed the relationship between transportation and institutionalization, as parents described the lack of affordable transportation options as a primary factor in their decisions to send their children to live at the center. This was perhaps most clearly seen in the case of a resident who was formerly a day student at the center and was subsequently institutionalized when transportation costs to and from the institution became prohibitive for his family. It is evident that affordable and reliable transportation is central to the deinstitutionalization process: with adequate access to transportation, persons with disabilities can receive services from centers while living independently or with their families.

Like the Jordanian institution, the center revealed a complicated relationship between staff members and the family members of persons with disabilities. In this case, such tension became apparent in discussions of residents’ visits home. In focus groups, staff claimed parents did not know how to adequately care for their children when they left the institution; however, none of the interviewed parents reported receiving counselling or training from staff. 

Together, these two case studies highlight the varying services, facilities and lifestyles of the residents living in institutions. In contrast with the case of Jordan, where a recent Ministry reclassification of the institution as a training center for university students resulted in the removal of the institution’s vocational education program, the institution in Lebanon required all students to be enrolled in an educational progamme, thus better preparing residents for a life outside the institution. However, contrary to Article 19, both institutions showed similar responses from residents in relation to their freedom of choice where and with whom to live, as well as their isolation from the community. Thus, the case studies further strengthen the findings from the regional study of institutions that more work is needed to support the inclusion and independence of persons with disabilities residing in institutions, who often turn to these centres because there are no other options available. There are many steps that both governments and institutions can take to advance the implementation of Article 19, as will be outlined in the final chapter.