192 Chapter 7 Value for patients Despite the challenging implementation of the social network intervention in forensic psychiatric care, chapter 4 demonstrated that implementation was possible and provided an opportunity for patients to experience new and meaningful supportive interactions and to engage in social activities in the community. This accords with earlier observations, which showed that the development of a reciprocal personal relationship between psychiatric patients and volunteer coaches was the most important achievement (McCorkle, Dunn, Wan, & Gagne, 2009; McCorkle et al., 2008). In our study, however, these meaningful experiences did not lead to noticeable and lasting changes in social networks of patients. Consistent with these findings, in chapter 5 we demonstrated that the addition of the social network intervention was not effective in improving mental wellbeing and social network characteristics in patients. We consider several possible explanations for the lack of sustained value for patients (chapter 4 and 5). The findings could be explained by patients’ low adherence to the additive intervention – challenges in implementation. In a recent review it was suggested that higher levels of exposure in interventions are warranted to show improvements on mental wellbeing in psychiatric patients (van Agteren et al., 2021). Previous studies that examined comparable volunteer-linking interventions among patients with severe mental illnesses, with variable compliance levels and compliance problems, also revealed no improvements on psychiatric symptoms, mental wellbeing, quality of life, and self-esteem (McCorkle et al., 2008; Priebe et al., 2020). However, in contrast to our findings, previous studies among psychiatric patients did find benefits on social network characteristics, including social support (Bradshaw & Haddock, 1998; McCorkle et al., 2008; Priebe et al., 2020). Moreover, one study showed decreased psychiatric symptoms and increased mental wellbeing in patients who responded to the intervention (i.e., patients who showed increased social support) from baseline to 12 months (McCorkle et al., 2008). Therefore, we assume that improvement of supportive social networks of forensic psychiatric patients might require more time and effort given the multiple and enduring problems, which complicated continuous implementation (Bootsma et al., 2017; Pettus‐Davis et al., 2017). Besides, longer timeframes might be needed to develop trustful and supportive social relationships due to prior negative social experiences and triple stigma (i.e., negative thoughts and beliefs of people with a migration background, psychiatric problems, and criminal behavior) (Link et al., 2001; Mezey et al., 2016; Thornicroft et al., 2009). The abovementioned absent benefits on social network characteristics of forensic patients might also explain the null findings on mental health and wellbeing outcomes, as social
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