Most of the world’s countries today report that they comply with international human rights standards to promote full community inclusion for disabled people; yet actual implementation of inclusive practices is less than what is reported, and disabled persons continue to face several barriers to full inclusion in the community (United Nations [UN], Department of Economic and Social Affairs, 2018, p. 24). The employment rate of disabled people of working age is significantly lower than that for nondisabled people, and when employed, they receive lower wages than matched nondisabled workers. ‘Although not every person with a disability will work, we know that the vast majority want to work and are calling for real jobs’ (Kiernan et al., Reference Kiernan, Hoff, Freeze and Mank2011, p. 303).
In the hierarchy of social acceptance for people with different types of disabilities, people with intellectual disabilities (ID) are consistently found to be the least socially accepted and the most socially excluded (Ditchman et al., Reference Ditchman, Werner, Kosyluk, Jones, Elg and Corrigan2013), stigmatised and ostracised (Scior et al., Reference Scior, Hamid, Hastings, Werner, Belton, Laniyan, Patel and Kett2015, p. 101). They are considered to be neither socially nor professionally competent (Santilli et al., Reference Santilli, Nota, Ginevra and Soresi2014) due to the fact that (a) cognitive disabilities are less well understood in terms of etiology and limitations than physical disabilities (Miller et al., Reference Miller, Chen, Glover-Graf and Kranz2009, p. 213); (b) intellectual disability is often comorbid with other impairments in speech, fine and gross motor skills, as well as with emotional–behavioural conditions, such as high anxiety and poor anger control (Parmenter, Reference Parmenter2011); and (c) ‘an intact intellect has historically been highly valued and often seen as the essential characteristic of being fully human’ (Parmenter, Reference Parmenter2011, p. 4). In the workplace, compared with persons with different types of physical illnesses and disabilities, people with mental conditions (disabilities and illnesses) have the highest stigma rankings (Baldwin & Marcus, Reference Baldwin and Marcus2006), and are more likely to be found in sheltered employment (Verdonschot et al., Reference Verdonschot, deWitte, Reichrath, Buntinx and Curfs2009). In many countries, the concept of inclusion of people with ID is viewed as unachievable, while the default segregation model prevails (Scior et al., Reference Scior, Hamid, Hastings, Werner, Belton, Laniyan, Patel and Kett2015, p. 38).
Although people with ID are entitled to benefit from the provisions of the United Nations (UN) Convention on the Rights of Persons with Disabilities (CRPD) and from international labour standards (such as the 1983 International Labour Organization [ILO] Convention concerning Vocational Rehabilitation and Employment; Parmenter, Reference Parmenter2011), their participation rate in the labour force has remained flat (Kiernan et al., Reference Kiernan, Hoff, Freeze and Mank2011), and their employment rates are the lowest (Santilli et al., Reference Santilli, Nota, Ginevra and Soresi2014). The persistent negative stereotypes with which they are associated are due to their inability to assert their rights (because of limited communication and cognitive resources), and their poor representation in disability rights movements where they have to rely on others — including parents — to advocate for their rights (Scior et al., Reference Scior, Hamid, Hastings, Werner, Belton, Laniyan, Patel and Kett2015)
Barriers to independent living for people with ID take many forms, some of which are external such as stigma, discrimination, abuse, exploitation, and denial of opportunities for growth and self-fulfilment by loving but overprotective families (Jahoda et al., Reference Jahoda, Wilson, Stalker and Cairney2010) as well as low parental expectations of successful achievements in education or in training for subsequent employment (Grigal et al., Reference Grigal, Hart and Migliore2011). In addition, the frustrations experienced due to the inability to find a job create a state of learned helplessness in disabled people as well as a ‘self-fulfilling prophecy of incompetence’ (Wehman et al., Reference Wehman, Inge, Revell and Brooke2007, p. 5).
In the Middle East, the unemployment rate among disabled people is higher than 80% (Axelsson & Barrett, Reference Axelsson and Barrett2009; Combaz, Reference Combaz2018; ILO, 2013; World Health Organization [WHO], 2011). This is due to several factors including physical inaccessibility of the workplace, unequal geographical distribution of services due to their concentration in the larger cities, stigma regarding disability, and poor quality of vocational training (WHO, 2011). Action to end discrimination against disabled people through disability legislation has remained elusive. In the 18 Arab countries in Western Asia, there is greater emphasis on ‘what should be done, by whom and how’, rather than on practical, results-based action plans (Economic and Social Commission for Western Asia [ESCWA], 2010). Marginalisation and exclusion of disabled people seem to be self-perpetuating (ESCWA 2017) and disabled persons remain one of the underserved groups in society (ESCWA, 2018).
Lebanon is one of the 18 Arab countries comprising the ESCWA region (Bahrain, Egypt, Iraq, Jordan, Kuwait, Lebanon, Libya, Morocco, Mauritania, Oman, Palestine, Qatar, Saudi Arabia, Sudan, Syria, Tunisia, the United Arab Emirates, and Yemen). In Lebanon, disabled people constitute around 10% of the total population (Lebanese Civil Society’s Coalition, 2015) and these are at the bottom rung of poverty (Lebanese Council of Disabled People, 2005) as 81.22% of disabled people are not employed, nor did they have any previous employment, while the majority of those employed work in fields that do not require any technical and vocational training (Combaz, Reference Combaz2018; ILO, 2013). Key figures from 2016 (United Nations Development Programme [UNDP], 2017) reveal that 86% of the total number of registered disabled people (98,000) in Lebanon are above 18, thus of employable age. A report published in 2018 by the Issam Fares Institute for Public Policy and International Affairs at the American University of Beirut (IFI) and the Arab NGO Network for Development (ANND) was able to obtain employment information from 43 Lebanese disabled persons of all ages; the report reveals that 50% of those were unemployed, and of those employed (full-timers, part-timers or casual workers combined), 64% earned monthly wages less than US$200, and 0% earned monthly wages of US$500 and above. More than 75% of those employed reported spending their income on health services, with purchase of medications comprising the largest out of pocket healthcare-related spending (IFI and ANND, 2018).
Aim
Data on the employment situation of people with ID in Lebanon is nonexistent, except for a few subjective anecdotal accounts of employment experiences posted on websites of nongovernmental organisations (NGOs) catering for people with ID. Most of the literature on the employment of disabled people in Lebanon, when available, focuses on either physical and/or sensory disabilities. This article identifies the major needs of people with ID in Lebanon, as they emerge from a background review of the employment situation in Lebanon of disabled people in general. Three needs are identified, calling for immediate action. These are described as the needs for (1) more visibility of, (2) more contact with, and (3) more modern, market-competent vocational training of people with ID in Lebanon. No such discussion has been located in the existing literature on intellectual disability in Lebanon. As such, this article aims at triggering more research into the proposed identified needs, eliciting further reflection on the employment situation of people with ID and more practical action in that direction on behalf of governmental agencies as well as the civic society.
Literature Review
Disability statistics on the employment of disabled people in Lebanon, and specifically people with ID, are not available. An initial literature search for peer-reviewed articles using electronic databases (i.e., PsycINFO, Academic Search Premier, JSTOR, and Google Scholar, in addition to Arabic databases such as Al-Manhal, Dar Al-Mandumah and periodicals in Shamaa [Arab Educational Information Network]) was made using the following keywords: inclusive employment of people with ID, inclusive employment in the Middle East, inclusive employment in Lebanon, intellectual disability in Lebanon. This search yielded 41 articles, of which only four exclusively dealt with ID in Lebanon. To avoid any confusion, three articles were excluded from this initial set due to their focus on (a) children with ID who are not of working age; (b) people with autism spectrum disorders (ASD) who may or may not have ID; and (c) special education in Lebanon, which concerns school education and does not include prevocational or vocational training. Due to the limited number of Lebanese resources, the search had to be extended to additional keywords such as mental retardation in Lebanon, sheltered employment in Lebanon, and Down syndrome in Lebanon, of which yielded three more resources.
A second round of literature search targeted grey literature (international, governmental or institutional reports and websites) from the year 2000 (with the adoption in Lebanon of Law 220 on the Rights of Disabled Persons [Law 220/2000]) and later. New keywords were added to the preceding original list to include mental health and mental disabilities. This search yielded 23 resources comprising the WHO, the ILO, Inclusion International, Mencap, Handicap International, the ESCWA, the United Nations Children’s Fund (UNICEF), the UNDP, and the United Nations Educational, Scientific and Cultural Organization (UNESCO). Many of these reports had to be analysed with caution, and sometimes discarded at the analysis stage due to (a) the ambiguity in the use of the term mental disabilities (confusingly alternating between including and excluding ID from the analysis); and (b) the misleading terminology for intellectual disability which, in the case of Mencap (2018) and Forrester and colleagues (Reference Forrester Jones, Gore and Melling2010), for instance, falls under the category of learning disabilities, or, in Abou Samra and colleagues (Reference Abou Samra, Soueidan, Hilal and El-Jardali2018), under the category of developmental delay. All articles and reports using the term intellectual disability based on the two criteria of (1) deficits in intellectual functioning, and (2) deficits in adaptive functioning, as set in the Diagnostic and statistical manual of mental disorders (5th ed.; DSM-5; American Psychiatric Association [APA], 2013), were included in the present article. No specifications as to the level of impairment (mild, moderate or severe) were applied. Similarly, articles and reports dealing with people with mental illness were excluded, as the nature of the stigma across different cultures of the world regarding the inclusion of people with mental illness - usually consisting of negative stereotypes about mental illness that include dangerousness, unpredictability, incapability, shame and blame (Quinn & Knifton, Reference Quinn and Knifton2014) — differs from that of the stigma regarding the inclusion of people with intellectual disability. Further reports had to be discarded at the analysis stage of the present article due to their focus on regional rather than Lebanese data, of which the latter data being totally absent in some reports.
In addition to these sources, this second round of search included the official website of the Ministry of Social Affairs (MOSA), the main governmental authority on disability in Lebanon), and websites of four different NGOs operating in Lebanon and catering for people with ID, to look for any data pertaining to employment statistics and practices. The NGOs were selected from four different areas in Lebanon to ensure geographical, subcultural and religious representativeness of the populations being served.
Historical Overview of Disability Activism in Lebanon
In order to understand the present employment condition of people with ID in Lebanon, it is important to place it in the context of the history of disability activism in Lebanon. The interest in disability mushroomed during the 1970s and 1980s, which were the civil war years in Lebanon, and when the warring factions started establishing their own rehabilitation centres to cater for the needs of their wounded combatants; a true rehabilitation industry started, supported by the flow of international funding from the United States and Europe, and later, by some Arab countries. As the number of persons with war disabilities was increasing, the number of rehabilitation centres increased and spread all across Lebanon.
All such rehabilitation initiatives were initially based on the medical model of disability, aiming at correcting the impairment (Axelsson & Barrett, Reference Axelsson and Barrett2009). Gradually, international donors introduced a human rights–based approach to disability that attracted many local disability professionals as well as disabled people. This led to the creation of new organisations, some of which run by disabled persons, that began lobbying for a social, human rights–based model to replace the prevailing charity/medical model of disability (Azzi, Reference Azzi2012; Combaz, Reference Combaz2018).
By 1994, the civil war in Lebanon had ended and the shift from the medical model to the social model of disability was strongly felt among NGOs and social activists in Lebanon. More emphasis was now being placed on the removal of social barriers (attitudes bestowed by society treating the impairments of disabled people as pathologies that restrict them from full participation in society), and policy, as well as the call for structural accommodations (such as creating accessible environments). As such, according to ESCWA (2010), Lebanon served as a leading model of the type of empowerment needed for disability policymaking, thanks to the close partnership between the Lebanese government and the civil society sector, embodied in the mechanism known as the National Committee for the Disabled [NCOD] that served as an excellent base from which the interests of disabled persons have been advanced at the national level (Axelsson & Barrett, Reference Axelsson and Barrett2009). One of the earliest achievements of the NCOD was the issuing of the disability card, which led to the official registration of many disabled people, thus contributing to the unprecedented establishment of a statistical register for disability in Lebanon (Kabbara, Reference Kabbara, Hodges-Aeberhard and Raskin1997).
In Lebanon in 2000, Law 220 was adopted. This law was perceived as one of the most progressive in the Middle East region (UNFPA, 2007). Law 220/2000 is based on the UN Standard Rules for Equalization of Opportunities for Persons with Disabilities, and on the World Program of Action Concerning Disabled Persons. It covers the rights of disabled people in all sectors including education, employment, medical services, sports, recreation and access to public transport and other facilities. Law 220/2000 was followed by the proclamation of the 2001–2010 Lebanese Disability Decade, which called on the Lebanese government to support sheltered workshops and placement offices to facilitate access of disabled people to employment, and to ensure proper education, rehabilitation and training prior to the implementation of inclusive employment.
These progressive ideas did not advance to the implementation level due to the many challenges facing Lebanon, namely: the detrimental economic consequences of the Lebanese civil war (1975–1990), the precarious security conditions of Lebanon, the heavy toll of financial debts, the many flaws of the political system, and the country’s present fragile economic situation. Obviously, inclusion of disabled people was not considered a priority item for the successive Lebanese governments. Underlying all these challenges is the sociocultural stigma against disabled people. This stigma is the most challenging obstacle, the most deeply ingrained, and, as such, the least likely to be eradicated.
Overview of the Employment-Related Articles in Law 220/2000 and Their Implementation
Briefly described, Articles 68 to 75 from Law 220/2000 relate to the right to work and employment for disabled people. Article 71 stipulates that every disabled person who is above 18 years of age and is a holder of the disability identification card is considered unemployed and will benefit from unemployment indemnity, which amounts to 75% of the minimum wage, paid by the Ministry of Labor. Articles 73 and 74 of Law 220/2000 stipulate that the private and public sectors have to employ disabled persons according to a preset quota. In the public sector, the quota is set at 3%, and in private companies with 30 to 60 employees, one qualified disabled person must be hired; in private companies with more than 60 employees, the 3% quota applies. The law provides important incentives for the private sector to employ more disabled people, which is mainly by tax reduction (UNFPA, 2007); however, noncompliance with the law would result in penalties (ILO, 2013).
Monitoring the implementation of Law 220/2000, the Lebanese Physically Handicapped Union [LPHU] (2003) noted (a) a persistence of workplace discrimination and disregard for the implementation of Law 220/2000, and (b) an absence of a strategic government mainstreaming plan. Based on disability employment statistics in Lebanon starting from the year 2000, the employment situation of disabled people in Lebanon was such that in 2006, while the number of Lebanese disabled persons of working age was estimated at 33,923 of which 27,086 are capable of working, only 7,052 were actually working (UNDP, 2008). While Law 220/2000 stipulates that the government support employment of disabled people in the mainstream labour market, government-funded institutions in charge of the education of disabled people did not provide them with the necessary technical and/or vocational skills to get jobs in the market, and ‘leave them with skills that can earn them only charity wages’ (Lakkis & Thomas, Reference Lakkis and Thomas2003, p. 11). More than 19 years after the adoption of Law 220/2000, the right for employment for disabled people in Lebanon has not been realised, and Law 220/2000 has not yet been efficiently implemented. For example, Article 74 of the law penalises employers who do not recruit disabled people (a penalty of twice the minimum wage for every nonrecruited qualified disabled person). To this day, there has been not one instance where Article 74 has been applied, whether at the monitoring level or concerning the collection of fines. Actually, the penalties under Article 74 were later suspended by the Ministry of Labor because of the harsh economic pressures on the private sector, and no alternative mechanism was put in place.
Employment Situation of People with ID in Lebanon
Work plays a very important role in the life of persons with ID because it contributes to an improved self-image and an enhanced self-esteem (Santilli et al., Reference Santilli, Nota, Ginevra and Soresi2014). Adults with ID prefer employment outside sheltered workshops, and this preference is not associated with the severity of the disability (Migliore et al., Reference Migliore, Mank, Grossi and Rogan2007).
In Lebanon, while data on employment of disabled people is scarce, data on the employment of people with ID is even sparser, if available at all. However, given that (a) compared with persons with different types of physical illnesses and disabilities, people with mental conditions (disabilities and illnesses) have the lowest employability rankings (Baldwin & Marcus, Reference Baldwin and Marcus2006); (b) the illiteracy rate for people with intellectual disabilities in Lebanon is as high as 78% (Inclusion International, 2006); and (c) unemployment of disabled people in Lebanon is as high as 81.22% (ILO, 2013), one can speculate that the employment rate of people with ID is extremely low in Lebanon.
Sociocultural Influences on the Employment of People With ID in Lebanon
The same factors that have impeded the inclusion of disabled people in the mainstream Lebanese labour force in the first decade of the 21st century still prevail: inaccessible and nonuser-friendly transportation means and work environments (ILO, 2013); inadequate technical and vocational training (WHO, 2011); discriminatory recruitment practices favouring nondisabled people; and the stigmatising impact of the charity model of disability. For people with ID, one additional factor stands out; that is, the stigma about their cognitive capacity (WHO, 2011).
The stigma about employing people with ID has two poles: pity, leading to benevolence; and fear, leading to hostility (Jahoda et al., Reference Jahoda, Wilson, Stalker and Cairney2010). In Lebanon, children, youth and adults with ID, as well as their families, are perceived with a sense of pity that leads to acts of benevolence, often translated in abundant material donations especially during religious occasions such as Christmas or the month of Ramadan. This charity-oriented attitude contributes to the persistence of the cultural stigma regarding intellectual disability; it relieves the feeling of guilt for not including people with ID in one’s circle by reinforcing one’s sense of self-satisfaction associated with one’s generosity. Research has shown a positive correlation between one’s perceived guilt and prosocial or helping behaviour (Torstveit et al., Reference Torstveit, Sütterlin and Lugo2016). De Luca and colleagues (Reference De Luca, Ferreira and Botelho2016) investigate the ‘phenomenon of philanthropy under the guilt hypothesis’ (p. 45) by reviewing a substantial amount of studies that confirm the view that negative emotions, such as guilt, may regulate charitable behaviour for the needy, and even increase the amount donated. Thus the philanthropic act is believed to yield psychological benefits for the donor, among which is the alleviation of feelings of guilt, and the satisfaction of a desire to be a morally just person.
The other pole is fear that leads to hostility. Most of the fear is related to the anticipation of violence from people with ID; people are more willing to include persons with physical disabilities in their circle than persons with ID or mental disabilities (Combaz, Reference Combaz2018). Sometimes, it is the relatives of persons with ID who contribute to the discriminatory practices, such as using physical and medical restraint to prevent the family member with ID from leaving the house and/or harming themselves or others (Stade et al., Reference Stade, Khattab and van Ommering2017). In their report to UNICEF on knowledge, attitudes, and practices of a total sample of 7,000 households consisting of Lebanese citizens from the eight Lebanese mohafazats (governorates), as well as Palestinian and Syrian refugees in Lebanon, Stade and colleagues (Reference Stade, Khattab and van Ommering2017) note that the majority of all respondents were moderately more accepting of school inclusion for children with physical disabilities than for children with ID, stating that specialised schooling would be of greater benefit for them (a) because of its tailored curriculum, and (b) because it is a safer environment for them (they will not be bullied as in the regular schools), and for others (they might be violent and injure other students in the regular schools). Respondents who were most sceptical about inclusive education reported fears that their own children would be hurt or would copy the behaviour of disabled children (Stade et al., Reference Stade, Khattab and van Ommering2017, p. 219).
As a result of this bipolar stigma against intellectual disability in Lebanon, an alarmingly low percentage of people with ID are literate; public schools in Lebanon are not a welcoming environment for disabled children; they are not properly equipped to cater for children’s learning difficulties and teachers are not properly trained to deal with intellectual disabilities in their classrooms. In the private sector, when available, inclusive education is very costly and can be afforded only by families from upper social classes. Most children with ID are educated in specialised social care centres that are partly subsidised by the MOSA, and these centres are not subject to any monitoring by the Ministry of Education (Combaz, Reference Combaz2018). The social care centres in Lebanon vary greatly in the quality of educational services that they provide for people with ID; however, all centres try to include functional academics in their curricula in order to foster some degree of everyday life autonomy in their students and prepare them for a vocational career. All centres include sheltered workshops for vocational training that cover more or less the same range of artisanal vocations across all centres (carpentry, pottery, pastry making, art crafts, mosaic decorative work, painting on glass, etc.).
Most of the youth with ID who have received these types of vocational training never get to leave the institution and never become integrated in the real labour world. Several reasons explain this situation: (1) the type of skills they receive do not match the type of skills needed in the real market today, as most of their training is artisanal rather than technical; (2) some parents are reluctant and fearful to see their youth leave the sheltered workshop for the outside world; (3) institutions do not have the right mechanisms to follow up on the progress of their graduates outside the institutional walls, or to monitor their safety and ensure protective measures against any kind of abuse; (4) there is great difficulty in finding the right market that will accept integrating people with ID because of the social stigma; and (5) nondisabled coworkers find it embarrassing to be working in the same place as people with ID, which could result in hostilities, harassment and violence against them. Stade and colleagues (Reference Stade, Khattab and van Ommering2017) reported that 67% of the Lebanese respondents were in favour of inclusive employment for people with physical disabilities, while only 25% favoured employment for people with ID, whom they describe as limited in comprehension, limited in productivity and may cause embarrassment. However, most respondents suggested disabled people ‘work from home or from specialised centres on artisanal and handicraft work. In other words, while the right to work is acknowledged, inclusion of persons with disabilities into the regular workforce is not preferred’ (Stade et al., Reference Stade, Khattab and van Ommering2017, p. 227).
Economic and Political Influences on People With ID in Lebanon
Years after the Lebanese civil war ended, disabled people are still at the mercy of flawed governmental policies that maintain them in a state of dependence instead of empowering them toward independence and full participation (Lebanese Council of Disabled People, 2005). Progress on translating legislation into practical change has been very slow (ESCWA, 2017). Lebanon still suffers from ‘the lack of enforcement mechanisms to ensure that policies are respected and implemented and adequate financial and human resources are allocated for the implementation of the legislation’ (Axelsson & Barrett Reference Axelsson and Barrett2009, p. 27).
In Lebanon, the same barriers that have stood in the way of inclusive employment of disabled people in general apply for people with ID. These barriers include lack of a coherent dialogue and coordination among the different concerned authorities, weak or unstable political will and commitment on behalf of governmental mechanisms, institutionary and budgetary constraints (Axelsson & Barrett, Reference Axelsson and Barrett2009), as well as the prevailing assumption by employers that disabled persons, and more specifically persons with ID, are unable to work (ILO, 2013; UNDP, 2008). The ANND (2010) denounces the lack of a comprehensive national vision for the rights of disabled people, in light of (a) the absence of inclusion standards in all domains (education, recreation, transport, employment, etc.); (b) the lack of interministerial coordination; and (c) the systematic deprivation of disabled people from their basic rights for productive self-development (ANND, 2010).
Since it began in 2011, the crisis in Syria has led to the massive exodus of Syrians seeking refuge, mostly in neighbouring Arab countries such as Jordan and Lebanon, leaving a significant social and economic impact on the labour markets of host countries. Lebanon is hosting the largest number of refugees per capita (the government estimate of the total Syrian displaced population is 1.5 million; United Nations High Commissioner for Refugees [UNHCR], 2019). Consequently, it is estimated that the impact of the Syrian refugee influx on the Lebanese labour market would result in pushing the existing poor deeper below the poverty line, with greater poverty being especially felt in regions of higher preexisting poverty and vulnerable populations (ILO, 2015). This is a real concern for disabled people in Lebanon who, as a vast majority, are poor, living in the poorest and most deprived regions in the country, and are uneducated and unemployed. In light of this, it is saddening to realise that there has been a deprioritisation of disability concerns at the expense of other nationwide problems (economic fragility, war refugees and displaced persons, the threat of terrorist activity, etc.), and in this deprioritisation process, intellectual disability has been relegated to an issue of minor importance.
Needs of People With ID in Lebanon
The Need for Visibility and Contact
Most literature on ID in Lebanon mentions that stigma against ID leads the families of people with ID to isolate them from full community participation and segregate them in specialised centres that provide them with rudimentary literacy and vocational skills, which are an unfit match with what is needed in the open labour market. Such segregation reduces the visibility of people with ID. This reduced visibility serves to (a) further widen the knowledge gap that people have about intellectual disability, (b) increase the apprehensions and negative expectations people have about the behaviour of people with ID, (c) reinforce the deprioritisation of the rights of persons with ID, and (d) render any form of eventual contact with persons with ID undesirable, embarrassing and often unacceptable. Unfortunately, the few times where persons with ID are seen publicly, for instance on Lebanese television, are poignant portrayals of their condition for the purpose of organisational fund raising, especially on religious occasions; a fact that further reinforces the pity/benevolent dimension of the stigma about ID. Thus it appears that the picture of intellectual disability with which people are most familiar is associated with incapacity, dependence and, of course, illness.
The visibility of people with ID that is needed today is one that targets everyday random life situations where contact with people with ID is promoted; children with ID playing with nondisabled children, youth with ID indulging in normal everyday activities alongside nondisabled youth, and adults with ID working in the open market alongside nondisabled adults. Such portrayals put people with ID in positive contexts, and the frequency in which they appear, produces a familiarity effect that may serve to change the cultural mindset about intellectual disability.
Research clearly shows that previous contact with people with ID (e.g., having a relative with ID, or having cared for a person with ID) increases positive attitudes toward intellectual disability (McManus et al., Reference McManus, Feyes and Saucier2011). Even indirect contact with people with ID (through exposure to a short film on intergroup contact) has been effective in changing inclusion attitudes and social distance, with effects maintained at one month (Walker & Scior, Reference Walker and Scior2013). A systematic review of 75 studies by Scior (Reference Scior2011) on attitudes regarding ID reveals that contact with people with ID is generally associated with more positive attitudes toward ID in several cultures; for example, in Japan (having a friend who has a family member with ID, having experienced contact with a person with ID during school years); in Canada (having a family member with ID); in Australia (having had contact with people with ID and attended an awareness disability program); in the United Kingdom (having had contact with students with ID in college); in Korea and in the United States (familiarity with people with ID predicting more comfort in interacting with hypothetical individuals with ID).
Allport’s Reference Allport1954 seminal work on prejudice proposes that familiarity breeds liking through the hypothesis that intergroup contact reduces prejudice between groups. However, to be effective, familiarity with the ‘other’, through direct or indirect contact, must incorporate certain conditions such that (a) both groups must be actively engaged toward the realisation of common goals; (b) both groups must cooperate, not compete, toward the attainment of common goals; and (c) both groups must be working under the auspices of a supportive authority that establishes norms of acceptance (Pettigrew, Reference Pettigrew1998; Pettigrew & Tropp, Reference Pettigrew and Tropp2006). Allport’s theory has received substantial empirical evidence across a variety of societies and situations beyond the traditional racial and ethnic research contexts (including among others, disabled people). When these conditions do not apply, the contact-liking hypothesis fails, and when all conditions are optimal, it leads to significant increases in intergroup tolerance, liking and esteem; however, most studies report positive contact effects even in situations lacking key conditions (Pettigrew, Reference Pettigrew1998).
Allport’s theory can be used to further emphasise the role of contact in promoting the inclusion of people with ID in the mainstream labour market. That is, when people with ID are placed in the same situation (the workplace) as nondisabled people, when they are engaged in a productive activity aiming to a common goal (Condition A), when such engagement occurs in a context of cooperation and excludes any type of competition (Condition B), and when the system (the workplace authority) fully supports the contact between both groups (Condition C), such an intergroup contact situation is bound to (1) generate ‘affectivity’ toward workers with ID, as continued contact generally reduces anxiety (Pettigrew, Reference Pettigrew1998, p. 71); (2) reduce anticipations of undesirable conduct by people with ID; (3) improve people’s knowledge of the potentials and abilities of persons with ID and correct misconceptions people have of ID, for ‘learning about the out-group’ reduces prejudice against it (Pettigrew, Reference Pettigrew1998, p. 70); and eventually (4) contribute to the reduction of stigma against people with ID.
The Need for Improved Vocational Training
A further need related to people with ID in Lebanon has to do with the quality of available technical and vocational training. No appropriate employment opportunities can be provided for disabled people when they are not properly trained. In Lebanon, there have been few initiatives in the private sector to employ people with ID, and their recruitment depended on their abilities and the degree to which their skills matched the available jobs. Such initiatives should be encouraged, well documented, monitored and assessed for their feasibility and successful outcomes, and replicated in a larger range of industries, hence the call for a specialised quality of training for people with ID to match today’s required market needs. Sheltered employment should be the means toward open-market employment, not an end by itself, as is the case in most organisational training workshops. People with ID should not be eternal trainees in a sheltered workshop where, too often, they are not being remunerated because of their trainee status.
Young people with ID today need a more modernised training setting making use of technology. Wehmeyer et al. (Reference Wehmeyer, Palmer, Smith, Parent, Davies and Stock2006) performed a meta-analysis of 13 single-subject design studies involving a total of 42 participants with intellectual and developmental disabilities with ages ranging from 12 to 37 years. Their findings confirmed that technology use can contribute to more positive vocational and employment-related outcomes for youth and adults with ID. Technology devices comprised audio prompting devices, video-assisted training, computers, and augmentative and alternative communication. Vocational and employment-related outcomes included work-related social skills, task sequencing and transition skills, vocational task performance and completion, food preparation skills, vocational assembly skills, requesting assistance on a vocational task, general cleaning skills, and computer use. The authors emphasise some of the principles technology should abide by when used with people with ID; these include flexibility (inherent accommodations to fit individual preferences, abilities and pace), simplicity and intuitiveness of use, and provision of multiple supportive prompts (graphic, visual, or audio directions).
Discussion
Several implications for further action toward the implementation of inclusive employment of people with ID in Lebanon have emerged from the preceding analysis.
Finding employment for persons with ID in the open market is not an easy task. Employment is not just a matter of having a job that is remunerated; it is also about being in contact with other people, and being socially accepted within a group. Employment is important for people with ID because it reduces their isolation. Of equal importance for sustainable employment of disabled people is the acceptance by colleagues (Vornholt et al., Reference Vornholt, Uitdewilligen and Nijhuis2013). Hence, the importance of intergroup contact theory as a frame for promoting mutual acceptance and generating positive feelings between groups; two conditions that are essential for the sustainability of positive group dynamics. The present study urges researchers in disability to further explore the intricacies of intergroup contact theory in the context of the inclusion of people with ID in community life (school, leisure and workplace) to test which contact processes work and which do not, and which variables seem to matter more than others.
However, change in people’s perceptions of ID will not occur as long as this problem of perception is not tackled from its root — the family. Ironically, although most organisations for people with ID in Lebanon stemmed from individual family efforts, most families who have a child with ID have so deeply internalised the stigma about ID that they have become detached from the question of human rights entitled to their child. The child with ID is left to grow in an overprotective environment that restrains them from well-rounded development, a situation that extends into adolescence and early adulthood, where parents become resistant to the idea of employment, fearing that their child will be exploited and abused.
Families of persons with ID should be supported, coached and empowered, not through the benevolent/pity perspective, but through a governmental and nongovernmental human rights perspective. The agenda of family-based organisations should shift its focus from pure service delivery to active advocacy for human rights, disability equality and policy change (Inclusion International, 2006). Families whose children are served by such organisations should not be content with the mere provision of services to secure their children’s needs; they should be made aware of the rights of their child for mainstream education, recreation, participation in community life and later, employment in the least restrictive, and abuse-free environments.
Conclusion
The historical review presented in this article, and the available data and current analyses show that the diligent work that has been done over the last decades by disabled people and by the Lebanese government toward creating a culture of diversity in the workplace unfortunately has not been as successful as hoped. Based on our assessment and understanding of the situation, the following reasons for the inefficient implementation of Law 220/2000 stand out:
The combined medical/welfare (charity) model of disability persists to the present day, in spite of all the efforts in favour of a social model based on human rights. The vast majority of children with ID are still educated and trained in specialised segregated centres and organisations that operate on the basis of service provision, and as long as they do so, funds can be generated for their support and survival. Efforts at speaking out and challenging marginalisation are not highly encouraged, nor are they materially supported.
The vigorous will of the 1980s and the 1990s to put disability on the social, economic and political agenda seems to have lost much of its impetus, due to the emergence of other priorities at the national and regional levels.
Organisations for disabled people, disability advocates and self-advocates do not seem to have established internal revision and evaluation of their objectives and strategies, nor have they sought to produce a fresh generation of younger advocates and self-advocates who can advance toward a more persuasive, more visible (especially on social media), and more proactive plan of action.
If serious initiatives are to be taken to stop the ongoing stigma against the employment of people with ID in Lebanon, then much has to be accomplished at the basic family level. This would assist families to develop a rights-based approach in their perception of their child as opposed to the medical or pure service-delivery approach, which is a very important step toward change. Parents of children with ID seem to confuse rights and services. Their advocacy efforts so far have been to ensure the provision of basic educational and health services for their children, most of which have been canalised through a segregated, institutional model. This article demonstrates that there needs to be a different kind of advocacy; one that urges the government and civic society to adopt an inclusive mainstream model, which goes beyond the mere provision of services. The poor visibility of people with ID in society is often due to parental overprotection or shame and embarrassment as a result of self-stigmatisation. Family empowerment is therefore a must, as it serves to decrease these negative discriminatory practices.
The stigma against ID may be reduced by encouraging contact with people with ID, of all ages, and in all situations of everyday life. People need to be more familiarised with intellectual disability and to learn more about it. Through increased knowledge and increased contact, negative prejudices and faulty conceptions about ID can be changed. Positive visibility of and increased contact with people with ID can eventually facilitate a change in the perception of their potential for employment.
In addition to visibility and contact, competence is a crucial factor for ensuring the success of inclusive employment of people with ID, and employment sustainability. The need for quality vocational training is a key factor in improving the employment situation of people with ID (WHO, 2011). Segregated sheltered workshops currently used as vocational training facilities for people with ID should gradually be converted into transitional training sites toward ‘real job for real pay’, as in supported employment enterprises that would ensure a comprehensive, modern and market-competent training for the youth with ID and facilitate integration in the open market.
Strategic planning, management and monitoring need data. In Lebanon, as in many other Arab countries, there seems to be a persistent shortage of reliable statistics on disability (ESCWA and the League of Arab States, 2014). Anyone who is genuinely interested in improving the situation of disabled people in Lebanon, from pure academic researchers to active policy planners and responsible decision-makers, is frustrated by the lack of data on which to base sound inclusive models and initiatives.
