Explain paranoid personality disorder and treatment limits — CASC communication station

Open and agenda-set. Name time available; acknowledge anger at the label; ask what he already heard; agree to cover diagnosis, treatment, medication, and the letter request. [1]

Explain diagnosis. "Paranoid personality disorder describes a long-standing pattern of expecting harm or betrayal, struggling to trust, reading threatening meanings into ordinary events, holding grudges, and often worrying about a partner's fidelity — enough that relationships and work suffer. It is a clinical description of a pattern, not an insult and not the same as saying you have schizophrenia or that you are 'crazy.' We look carefully at whether beliefs are fixed delusions or a long-term mistrust style." [2][3]

Explain treatment. Medicines do not reverse the personality pattern itself. We still treat depression, anxiety, sleep, and alcohol problems if present. Talking treatments that go slowly, stay transparent, and work on mistrust and relationships can help some people; evidence is more limited than for some other conditions, so we set realistic goals and keep reviewing. [1][4][5]

Letter request. You will not write a letter that falsely certifies his colleagues' intent as fact. You can document diagnosis, treatment offered, and functional impact factually, or direct him to independent legal advice. Collusion destroys both care and credibility. [1][3]

Confidentiality. Usual privacy applies, but if someone is in serious danger we may need to share limited information to protect them — we will be as transparent as safety allows. [3]

Close. Summarise shared goals (e.g. sleep, work stress skills, next session structure), teach-back, written information, hope without false promises. [1][4]