Background Over the past decade, there have been significant cuts to local authority (LA) budgets, which have not been felt equally across England. Cultural, environmental, planning and development (CEP) budgets have been disproportionately impacted as these services are largely discretionary. This budget line includes services such as parks, leisure centres, community development and libraries which have important implications for mental health outcomes. Therefore, the inequitable budget cuts to these services may have contributed to worsening mental health in recent years, as well as geographical inequalities in these trends. In this study, we investigated whether cuts to CEP services have affected mental health.

Methods Using fixed effects regression applied to longitudinal LA-level data in England, we assessed whether trends in CEP spend were associated with trends in mental health outcomes, between 2011 and 2018. The exposure was CEP spend and the main outcomes were the average Small Area Mental Health Index (SAMHI) and antidepressant prescription rate, compiled in the Place-Based Longitudinal Data Resource. The SAMHI ranges between -1.84 and 2.88. As an alternative measure of mental health, we used LA average anxiety level from the Annual Population Survey. Additionally, we considered subcategories of CEP spend. We further adjusted all models for total LA spending (all services except exposure), unemployment claimant rate and gross disposable household income (GDHI) per capita.

Results In the unadjusted model, CEP spend was associated with SAMHI, such that a 25% decrease in spending was associated with a small increase in SAMHI of 0.03 (95% CI: 0, 0.06; p=0.03), indicating worsening mental health. The effect of CEP spend is slightly smaller in the adjusted model (0.02, 95% CI: -0.01, 0.04; p=0.18). Planning and development services showed the largest impact on SAMHI, compared to cultural and environmental services. We found no significant associations with the alternate outcomes, though the directions of effect suggest decreasing CEP spend was associated with increasing rates of antidepressant prescriptions and average anxiety levels.

Conclusion Our study indicates that areas with the largest budget cuts to CEP services, and specifically planning and community development services, have experienced the worst trends in mental health. However, the potential impact of the budget cuts is small and further research is needed to explore the relationship between CEP spend, mental health and other drivers, such as income. One limitation of our study is that we conducted analysis at the area level, which may not be sensitive enough to identify trends in mental health.