Patients’ and volunteer coaches’ experiences with an informal social network intervention in forensic psychiatric care: a qualitative analysis

Abstract

Background: Improving supportive social networks in forensic psychiatric patients is deemed important due to the protective effects of such networks on both mental health problems and criminal recidivism. Informal interventions targeted at social network enhancement by community volunteers showed positive effects in various patient and offender populations. However, these interventions have not specifically been studied in forensic psychiatric populations. Therefore, forensic psychiatric outpatients’ and volunteer coaches’ experiences with an informal social network intervention were explored in this study. Methods: This qualitative study was based on semi-structured interviews conducted alongside an RCT. Forensic outpatients allocated to the additive informal social network intervention, and volunteer coaches, were interviewed 12 months after baseline assessment. Interviews were audio-recorded and transcribed verbatim. Reflexive thematic analysis was used to identify and report patterns in the data. Results: We included 22 patients and 14 coaches in the study. The analysis of interviews revealed five main themes reflecting patients’ and coaches’ experiences: (1) dealing with patient receptivity, (2) developing social bonds, (3) receiving social support, (4) achieving meaningful change, and (5) using a personalized approach. Patient receptivity, including willingness, attitudes, and timing, was a common reported barrier affecting patients’ engagement in the intervention. Both patients’ and coaches’ experiences confirmed that the intervention can be meaningful in developing new social bonds between them, in which patients received social support. Despite, experiences of meaningful and sustainable changes in patients’ social situations were not clearly demonstrated. Coaches’ experiences revealed broadened worldviews and an enhanced sense of fulfillment and purpose. Finally, a personalized, relationship-oriented rather than goal-oriented approach was feasible and preferable. Conclusion: This qualitative study showed positive experiences of both forensic psychiatric outpatients and volunteer coaches with an informal social network intervention in addition to forensic psychiatric care. Notwithstanding the limitations, the study suggests that these additive interventions provide an opportunity for forensic outpatients to experience new positive social interactions with individuals in the community, which can initiate personal development. Barriers and facilitators to engagement are discussed to improve further development and implementation of the intervention. Trial registration: This study is registered at the Netherlands Trial Register (NTR7163, registration date: 16/04/2018).

The effectiveness of an additive informal social network intervention for forensic psychiatric outpatients: results of a randomized controlled trial

“…Another explanation for the findings, including the temporary negative effects on mental wellbeing at 6 months, may be related to the overall low compliance of patients in our trial. Regarding the negative effects, for example, it is possible that patients with low compliance had more severe mental health problems and complex needs ( 69 ). Furthermore, although speculative, the failure to participate in the intervention and to develop a bond with the volunteer could cause frustrations, disappointment, or self-doubt.…”

“…On the other hand, we cannot rule out the influence of contextual factors, such as the COVID-19 pandemic, relationship problems, financial problems, and unstable housing. These factors may have complicated the contact between patient-coach dyads and prevented them from participating in social activities in the community, impeding the effects ( 69 , 70 ).…”

“…Interestingly, the per-protocol analyses showed that effects on criminal behavior were similar, and even slightly stronger, in patients who did not start with the additive intervention, compared to those in patients fully adhering. Based on our qualitative study, in which patients who were unwilling to start reported that they had enough social relationships and that they did not need assistance to improve their social network, we hypothesize that patients with no compliance could have been more self-sufficient in developing and maintaining social connections, as they refused to start with the intervention ( 69 ). Future research on patient characteristics between compliance groups, which was beyond the scope of the current study, should aim to reveal which patients are more likely to adhere to and benefit from the intervention.…”

“…There were challenges in the implementation of the intervention that may also hinder applicability, such as the availability of volunteers who matched the specific characteristics and needs of patients, preventing patients to start with the intervention conform protocol (i.e., within 2 months after their baseline assessment). Besides, the goal-oriented intervention protocol ‘Of course, a network coach!’ was not often used and was not considered feasible ( 69 ). Moreover, patients were found unwilling or unable to (timely) start with the intervention.…”

“…Regardless of the limitations, informal social network interventions are accessible and low-cost interventions that could provide a meaningful addition to current clinical practice for forensic outpatients with complex needs given its potential to improve treatment outcomes of hospitalization and criminal recidivism. Evidently, this is not a one-fits-all intervention, as the compliance as well as the effects may vary between individual patients ( 69 ). Therefore, a flexible implementation responding to patients’ abilities and needs, such as the frequency and type of contact, duration of the intervention period (i.e., open-ended or not), and the personalized process of matching patients to volunteers based on preferences and characteristics, seemed important requirements.…”