15 General introduction 1 Although some studies showed that forensic psychiatric care that complies with the RNR principles is most effective and is preferable to imprisonment in terms of treatment outcomes, evidence of effectiveness is still limited (Andrews et al., 1990b; Völlm et al., 2018). Furthermore, a meta-analysis found that significant treatment effects on criminal recidivism favoring the experimental conditions occurred in only a minority of forensic interventions (Wartna, Alberda, & Verweij, 2013a). Therefore, there is an urgent need to improve treatment effectiveness and develop evidence-based interventions for forensic psychiatric patients with complex needs (MacInnes & Masino, 2019; MacKenzie & Farrington, 2015; McIntosh et al., 2021; Völlm et al., 2018). In this dissertation, we focus on improving mental wellbeing of forensic psychiatric outpatients with an intervention aimed at strengthening social networks – one of the primary goods – in addition to forensic psychiatric care. Social networks of forensic psychiatric patients In general, the research on social networks is both extensive and complex, because it includes many aspects related to structural characteristics (e.g., size, roles or composition, density, quality, reciprocity) and functional characteristics (e.g., providing resources, positive and negative influences, companionship, and social support) (Heaney & Israel, 2008; House, 1987; Kawachi & Berkman, 2001). Regarding the social network size of forensic populations, a previous study found an average number of 5.9 social network members and 2.9 members in the core social network, consisting of people with whom probationers with mental and substance use problems spend most of their time (Skeem, Eno Louden, Manchak, Vidal, &Haddad, 2009). However, a study among forensic inpatients found an average number of 15 members with a large dispersion (SD = 7.6) (ter Haar-Pomp, Spreen, Bogaerts, & Völker, 2015). Therefore, the size of the network may vary across populations as well as on an individual level, and also depends on the type of measurement that was used. Despite this, previous studies demonstrated smaller informal social networks (i.e., personal network members, including family, friends, romantic partners, and peers) in forensic patients compared to general and other psychiatric populations (Skeem et al., 2009; ter Haar-Pomp et al., 2015; Wang et al., 2017). Furthermore, a decrease in the personal network size of forensic patients during inpatient treatment was shown (ter Haar-Pomp, Spreen, Völker, & Bogaerts, 2019). A study examining the core discussion network (i.e., the network consisting of people with whom a person discusses important issues) of prisoners revealed that although the network size remained stable throughout imprisonment, 60% of the network composition had changed after imprisonment (Völker et al., 2016).
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