Background Community development engages local communities in work for positive social change, such as improving local services and infrastructure. Local government funding for community development has been cut by 26% between 2011/12 and 2019/20, following the implementation of austerity and reduced central government regulation of services. In this study, we investigate the health inequalities impacts of community development budget cuts on mental health and well-being.

Methods We used fixed effects regression applied to longitudinal local authority-level data in England between 2011/12 and 2019/20. We assess whether trends in community development spending were associated with trends in mental health and well-being. The exposure was gross community development spending per person, adjusted for inflation. Outcomes were a composite measure of area-level mental health, the Small Area Mental Health Index (SAMHI) sourced from the Place-based Longitudinal Data Resource; the components of SAMHI; and self-reported measures of anxiety and life satisfaction, collected in the Annual Population Survey. We adjusted models for confounders and conducted interaction analysis to examine differential mental health effects of spending cuts based on the level of area deprivation. All analyses were conducted in R 4.0.2.

Results The average community development budget cut of 26% was associated with worsening mental health, as measured by a small increase in SAMHI of 0.009 (95% C.I.: 0.004, 0.014) standard deviations, a 0.034 (95% C.I.: 0.016, 0.051) percentage point increase in the prevalence of depression and a 0.67 (95% C.I.: 0.020, 0.113) ADQ per capita increase in antidepressant prescriptions. We found negligible impacts on well-being, as measured by self-reported anxiety and life satisfaction measures. Budget cuts in more deprived areas were associated with larger mental health impacts than those in less deprived areas. Sensitivity analyses excluding unitary authorities, due to differing spending trends and responsibilities, showed similar results.

Discussion Local government budget cuts to community development were associated with negative mental health impacts, especially in more deprived areas, widening the existing socioeconomic and geographic inequalities in mental health. A limitation of our study is that the outcome, SAMHI, may be influenced by differing prescribing and diagnosing trends between places and over time. We studied self-reported outcomes as well to address this. Community development should be prioritised as an investment strategy to support public mental health, especially as the government plans to ‘level up’ areas and address worsening mental health trends.