A 30-year-old African American man is referred to the PMHNP after a psychiatric emergency department visit where he was diagnosed with schizophrenia and started on haloperidol 10 mg daily. The referral note describes him as having paranoid ideation about being surveilled by authorities, disorganized behavior, and poor insight. During the outpatient evaluation, the PMHNP learns that the patient is a community activist who has been involved in publicized disputes with local law enforcement regarding civil rights violations in his neighborhood. He describes specific, verifiable incidents in which he was followed by police vehicles and had his phone records requested by authorities. He reports he has not slept well for 3 weeks due to stress from these events and acknowledges feeling angry and hypervigilant. He denies auditory or visual hallucinations. His thought process is linear and goal-directed. His affect is guarded but appropriate. He works full-time as a paralegal and maintains close relationships with family and a social network through his church. The patient reports feeling that his concerns were dismissed in the emergency department after he became frustrated when staff did not believe his account of police surveillance.