187 Summary and General discussion 7 social participation, and social support are associated with better mental health in psychiatric patients – positive social determinants of mental health (Almquist et al., 2017; Cohen & Wills, 1985; Harandi et al., 2017; Heaney & Israel, 2008; Jeste & Pender, 2022; Kawachi & Berkman, 2001; Ozbay et al., 2007; World Health Organization, 2022). Probably, a broader approach in mental healthcare, which includes a focus on enhancement of the social network surrounding patients in real life, could enhance availability of social support sources (i.e., family, friends, and peers) and help patients to rely more on social support from their environment in addition to professional support, improving supportive social networks and treatment satisfaction in patients. Furthermore, this broader treatment approach may induce a shift in attention from the individual being responsible for their recovery towards a shared responsibility of both patients and their social environment that contribute to recovery, which might explain the benefits on supportive social networks and treatment satisfaction (Price-Robertson, Obradovic, & Morgan, 2017). Consequently, enhanced supportive social networks and treatment satisfaction could stimulate patients to exhibit more health promoting behaviors or to make healthier decisions, such as engaging in mental health treatment and diminishing substance use (Cohen, 2004; Cohen & Wills, 1985; Pettus-Davis et al., 2011; Thoits, 2011). In general, our findings indicate that interventions targeting social network enhancement in real life should be encouraged during treatment of psychiatric patients. However, it should also be noted that effects of social network interventions on treatment outcomes of psychiatric patients are generally small and effects on psychiatric and psychological symptom reduction are inconclusive (chapter 2). Moreover, based on research up to date and the comprehensive nature of our meta-analytic study that included various types of social network interventions and different diagnostic patient groups, it is unclear whether the positive modest findings can be generalized to all types of interventions and subgroups of patients (Heaney & Israel, 2008; Kawachi & Berkman, 2001). Volunteers in forensic psychiatric care This dissertation was set out to examine an additive informal social network intervention, using trained community volunteers, in forensic psychiatric outpatients (chapter 3, 4, and 5). Before zooming in on the potential value of the intervention, in this section we would like to reflect on the implementation of the intervention that was examined in this dissertation. More specifically, on (1) why and how a collaboration between formal and informal care was established to implement the intervention in forensic psychiatric care and (2) the challenging implementation of the intervention (chapter 4 and 5).
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