195 Summary and General discussion 7 care with a focus on social network enhancement effectively reduced criminal behavior in outpatients, which is in line with previous research (Bales & Piquero, 2012; Wermink, Blokland, Nieuwbeerta, Nagin, & Tollenaar, 2010). The positive findings presented above are somewhat surprising given the fact that we found no improvements on subjective mental wellbeing, which was expected to contribute to treatment effects of hospitalization duration and criminal behavior. Therefore, we consider several alternative explanations for the positive effects of the social network intervention in forensic psychiatric patients. First, the provision of an additional support resource (i.e., social support from a volunteer) could be addressed as a potential active component of the intervention, reducing the duration of hospitalization and criminal behavior in forensic outpatients (Cohen, 2004; Cohen & Wills, 1985; Thoits, 2011). Consistently, previous studies demonstrated that more social support was related to reduced specialized psychiatric care consumption and reduced hospitalization (Albert et al., 1998; Maulik, Eaton, & Bradshaw, 2009). In chapter 4 we showed that patients received advice, information, and assistance from volunteer coaches, which was experienced helpful and motivating. Thus, social support may directly affect a person’s coping and behavior. Furthermore, social support could also lead to positive or prosocial perspectives, affecting risky and adverse health behaviors in patients (Pettus-Davis et al., 2011). In particular, we consider the informal character of the support between patients and volunteer coaches a potential influential aspect of the intervention. Informal support (e.g., support from family, friends, and peers) is deemed as important as support from professionals (Kogstad, Mönness, & Sörensen, 2013). Moreover, research showed that increased patient trust in their social network was found to be positively associated with trust in professional care and increased the likelihood of positive experiences with professional care, especially among vulnerable populations (Kogstad et al., 2013). Although it can be disputed whether volunteer support should be considered a source of informal support, as support of volunteers is obviously not the same as support of family and friends, patients and volunteer coaches generally described their bond as reciprocal and equal. Moreover, some patients even were referring to the relationship as a friendship (chapter 4). Therefore, we hypothesize that informal support could have increased adherence to formal care, which could have helped to further improve treatment goals in forensic psychiatric patients. Second, although speculative, the combination of informal support, a pleasant and equal contact with an individual from the community, and social participation, might induce self-esteem and a sense of mattering (i.e., the belief that one is acknowledged by others
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