When a patient expresses paranoid beliefs about surveillance, the best approach is to:

• A. Restrain the patient.
• B. Dismiss the belief as untrue.
• C. Provide a calm, factual explanation and assess safety.
• D. Remove the patient from the unit.

Answer: (C)

When someone is expressing paranoid beliefs about surveillance, the priority is to de-escalate and keep the person safe while maintaining trust. The best approach is to respond in a calm, non-threatening way and provide a factual, reality-based explanation while actively assessing safety. Acknowledge that the fear feels very real to them, then gently offer clear, non-arguing information: you can say you don’t have evidence of surveillance or that you can’t monitor everything, but you will help keep them safe and address their concerns. This approach reduces defensiveness and helps the patient stay engaged with care.

Assess safety right away: determine if there is any plan or intent to harm self or others, access to means, and any immediate risk factors. If safety concerns arise, implement appropriate safety measures and involve the treatment team. After addressing safety, continue with supportive communication, maintain consistent limits, and involve the patient in the care plan.

Why the other options aren’t right here: restraining the patient is a last-resort measure used only when there is imminent danger, and it can heighten paranoia and distrust. Dismissing the belief outright invalidates the patient’s experience and can erode trust, making future interventions harder. Removing the patient from the unit may feel punitive and does not address the fear or safety needs and can worsen anxiety and disconnection from care.