186 Chapter 7 GENERAL DISCUSSION Accumulating evidence of social network interventions in psychiatric care Since the onset of the deinstitutionalization of mental healthcare in the mid-20th century, the need for effective ambulatory and community-based care for patients with chronic and severe psychiatric problems has increased. Despite the provision of community care for psychiatric patients, it was discussed that patients still had difficulties with social integration in the community (Fakhoury & Priebe, 2007). For instance, psychiatric patients with severe and chronic problems often have co-occurring social network problems, such as limited social support and fewer reciprocal ties (Clifton et al., 2007; Pinto, 2006; ter Haar-Pomp et al., 2015; van der Post, Koenders, Dekker, & Beekman, 2019), which are likely to negatively affect mental health recovery (Schön et al., 2009). Against this background, the importance of building supportive social networks for psychiatric patients in the community was emphasized, resulting in the development of various social network interventions (Biegel et al., 1994). The research in this dissertation suggests that a focus on the enhancement of personal social networks, parallel to regular psychiatric care (i.e., care focusing on the prevention and treatment of mental disorders and, for forensic psychiatric care, reducing the risk of criminal recidivism), further improves supportive social networks as well as important treatment outcomes in (forensic) psychiatric patients (chapter 2, 4, and 5). Specifically, results from the meta-analysis showed that positive social networks and positive social support, general functioning, mental health treatment adherence, days substance use, and abstinence improved more in psychiatric patients receiving, often additive, social network interventions compared to usual psychiatric care (chapter 2). These findings are in line with previous reviews that provided modest evidence of various social network interventions on treatment outcomes among psychiatric populations (Anderson et al., 2015; Barnett et al., 2022; Brooks et al., 2022; Killaspy et al., 2022; Ma et al., 2020; Pinto, 2006; Shorey & Chua, 2022; Smit et al., 2022; Webber & Fendt-Newlin, 2017). In addition, our review investigated, for the first time, the effects of interventions with a focus on social network enhancement in real life on a wide range of treatment outcomes in psychiatric patients. An important conclusion of these findings is that supportive social networks of psychiatric patients can be further enhanced. Furthermore, the positive findings on other treatment outcomes (i.e., general functioning, mental health treatment adherence, and substance use) are not surprising, given the body of research emphasizing that social relationships,
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