Emotional Support Animals
Writing about emotional support animals wasn’t exactly the cool, “Instagram therapist” blog entry I was thinking would be my first post, but, alas, this is where we are. Recently, I’ve come across a lot of conversations about therapists writing emotional support animal (ESA) letters for their clients, and it seems to always lead to more questions than answers despite ample information available, albeit, not in the same place.
Here is how the US Department of Housing and Urban Development (HUD) defines an emotional support animals: “an assistance animal is an animal that works, provides assistance, or performs tasks for the benefit of a person with a disability, or that provides emotional support that alleviates one or more identified effects of a person’s disability. An assistance animal is not a pet.” (hud.gov) Their definition is the most important definition of an emotional support animal, which we’ll get to soon.
An emotional support animal is not a service animal or psychiatric service animal. Per the American with Disabilities Act (ADA), a service animal is “individually trained to do work or perform tasks for people with disabilities.” (Fun fact about service animals: in addition to dogs, as of 2011 miniature horses can also be trained as service animals!) These animals are protected under the ADA, which you can learn more about on their website, but the main gist is that anywhere the public can go, so can your service animal (ada.gov).
So what protections do emotional support animals have? Well, just one. The only accommodation that can be made for an ESA is through the HUD via the Fair Housing Act (FHA). Per this act, emotional support animals are allowed in housing that typically bans pets and any fees related to having pets is waived (Gibeault, 2021).
Wait, I thought you could fly with them? Didn’t some guy bring his peacock on a plane? Well, yes and no. Prior to 2021, a lot of airlines did honor emotional support animals as service animals before revisions to the Department of Transportation’s (DOT) Air Carrier Access Act. The problem with the policy before that is that emotional support animals are not service animals, which means they are not required to have any kind of training and could technically be any animal (maybe not a peacock though?). Obviously, this led to a lot of issues for airlines with people avoiding pet fees by calling their pets emotional support animals or showing up to the airport and on planes with poorly trained animals that are a danger to others, including service animals. The revision to the Air Carrier Access Act in 2020 meant that emotional support animals can be considered pets and if so, they are subject to all rules and fees associated with traveling with pets (transportation.gov). As far as I know, no US airline honors ESAs as service animals anymore.
So, what makes an emotional support animal an emotional support animal? Here is the general criteria needed for someone to designate their pet as an ESA:
A diagnosed disability, typically related to mental health, such as generalized anxiety or major depressive disorder.
The animal helps to reduce symptoms related to this disability
There needs to be documentation from a health care provider (typically a therapist or psychiatrist, but sometimes a primary care physician) stating the person’s disabilities and symptoms alleviated by the ESA (Clark, date unknown)
The documentation can then be shown to landlords/property owners. Landlords cannot ask for the specific diagnosis or any medical records, they can’t require a specific form be filled out, they can’t require a notarized statement, and they cannot ask the letter writer to make any statements under the penalty of perjury. (hud.gov)
There is no registry of emotional support animals. There is no organization that details a specific, formal process of getting your animal designated as an emotional support animal. Any “certificates” or “emotional support animal vests” are complete bullshit. There are a number of states that have been passing laws related to emotional support animals (Tin, 2020) and maybe we’ll start to see more guidelines in the coming years.
So, what other conversations are therapists having about this? Mostly how to write these letters and concerns about liability. While there really isn’t any real liability on a provider’s part writing these letters, theoretically anyone can try to take legal actions against you. The biggest concern providers have is “what if the animal bites someone?” Well, unless your letter states “this animal will never bite a person, so help me God,” the animal’s behavior is the owner’s liability, same as it would be for any animal. Other therapists just don’t really believe in emotional support animals. Other people have raised concerns that by writing the letter, you’re entering into a “dual relationship” with your client, as some may consider the letter as an “evaluation” (Galieti, 2018). I’d love more information on this, as the way I see it, your initial assessment of your clients and diagnosing them also constitutes an “evaluation.” Literally, the CPT code is “psychiatric diagnostic evaluation” for initial assessments.
I have written a few letters for clients before, and I will continue to do so. As someone who has a deep, loving relationship with one of my cats (my sweet bell Pepper), I understand how animals can play a huge role in our emotional regulation (co-regulation folks!) and overall mental health. I don’t see the point in denying our clients the ability to have a little more freedom in where they live.
Bear in mind a few things
Can you back up what you’ve written in your letter?
Is the emotional support animal on your treatment plan?
Do you have an established relationship with the client you’re writing the letter for?
If the answer is yes, you likely don’t have to worry about anything. There are guidelines that are much stricter than these suggestions, such as ensuring that your client can adequately care for the animal or asking about any specific training the animal has.
In the end, it’s your level of comfortability with the letter. In my letters, I state that this disability is protected under ADA guidelines, if my client is comfortable with it I will identify the diagnosis, and I state the symptoms that are alleviated by the presence of an animal. As guidelines update and we learn more, my procedure and letters will update as well.
This should go without saying, but I’m not an attorney or have any legal training. Just a person that likes facts. None of this should be taken as recommendations of how you should practice as a therapist.
References
Clark, Sarah. (Date Unknown). What Therapists Need to Know About ESAs, Disability Counseling Institute, https://disabilitycounseling.org/blog/what-therapists-need-to-know-about-esas
Galieti, Connie. (2018). A Psychologist’s Role in Providing Letters for Emotional Support Animals. Good Practice, https://www.apaservices.org/practice/good-practice/emotional-support-animals.pdf
Gibeault, Stephanie. (2021). Everything You Need to Know About Emotional Support Animals. American Kennel Club, https://www.akc.org/expert-advice/news/everything-about-emotional-support-animals/#:~:text=A%20therapist%2C%20psychologist%2C%20or%20psychiatrist,any%20age%20and%20any%20breed
Tin, Alice et al. (2020). Emotional Support Animals: Considerations for Documentation. American Family Physicians, 101(5):302-304, https://www.aafp.org/pubs/afp/issues/2020/0301/p302.html
US Department of Housing and Urban Development. (Date Unknown). Assistance Animals, https://www.hud.gov/program_offices/fair_housing_equal_opp/assistance_animals
US Department of Transportation. (2020). U.S Department of Transportation Announces Final Rule on Traveling by Air with Service Animals, https://www.transportation.gov/briefing-room/us-department-transportation-announces-final-rule-traveling-air-service-animals
