Social prescribing and horticulture therapy for autistic adults

Background

This PhD research project aims to explore the feasibility and acceptability of social prescribing for adults on the autism spectrum as a mechanism for improving health, wellbeing and quality of life. Social prescribing is an approach to healthcare involving referral from primary care to health-enhancing activities in local communities. These activities provide people with the opportunities and skills to improve mental health, physical and social outcomes and enhance community cohesion. Social prescribing may be able to mitigate some of the disparities in physical and mental health that affect autistic people and lead to a lower overall life expectancy. Targeted approaches to health may be difficult to implement for autistic people who are ineligible for learning disability or mental health services (around 70-85% of autistic people do not have a learning disability), when compounded with the barriers to accessing healthcare experienced by autistic people.

This research project will respond to the gaps in autism services and research identified by Autistica around service provision and quality of life aimed at autistic adults, who make up the majority of people on the autism spectrum. The NHS Long Term Plan has proposed to increase access to social prescribing to allow more people across the UK to access personalised healthcare, while the government’s Autism Strategy aims to increase provision of ‘low-level’ support services for autistic people at the community level. However, it is not yet known whether or how this will work to improve health and wellbeing outcomes for people on the autism spectrum. Horticultural and “green” therapies and activities, such as allotment groups or community gardening, are often available locally through social prescription. There is a growing body of evidence for the effects of “green” therapies and nature exposure on physical and mental health. However, such research has rarely focused on autistic adults and there is an evidence gap around self-reported outcomes of health and wellbeing for this population in relation to these activities and the social prescribing pathway. 

Research objectives

This research project aims to address some of the gaps in evidence as outlined above. In addition, social prescribing is now relevant to the response to Covid-19, with voluntary organisations well-positioned to respond to the needs of local communities. Working alongside health providers, community-level approaches may be able to help mitigate the effects of social distancing on physical and mental health and social isolation. The Covid-19 restrictions to services and access to communities has posed particular challenges for autistic people, with the potential to widen existing inequalities but also to explore different methods of service delivery which may increase accessibility of healthcare and community assets. This research will therefore be responsive to the context of Covid-19 in 2020 and beyond.

Our outputs so far include two literature reviews (awaiting publication) on health and wellbeing outcomes and social prescribing pathways relating to community-based service provision for autistic adults, and on the evidence for green therapies in improving health and wellbeing outcomes for this population.

Methods

We are now conducting a mixed methods study beginning with an online survey launched in Autumn 2020 which aims to explore the relationships between emotional wellbeing and access to healthcare, communities and green spaces, in the context of Covid-19 lockdowns. A follow-up survey has allowed us to measure these factors over time to examine how these experiences change for autistic adults as people and services adjust to new ways of working. We are also conducting interview-based qualitative research to explore the impact of these issues for individuals in detail. The results of these studies will highlight the impact of Covid-19 on wellbeing, quality of life and access to communities for autistic adults in the UK, and what can be learnt from this to enhance provision of social prescribing for this population.