What to Do If Patients Want Service or Emotional Support Animals

A patient asks the psychiatrist for a letter advocating for a service animal or for an emotional support animal. What is the difference between them? What is the psychiatrist’s responsibility when receiving such a request?

Service Dogs

Under the Americans With Disabilities Act (ADA), a service animal is defined as a dog (or miniature horse) that has been individually trained to perform tasks for an individual with a disability. The task(s) performed by the dog or horse must be directly related to the person’s disability. The disability may be physical, sensory, psychiatric, or intellectual. Psychiatric service dogs (PSDs) require extensive training to work specifically with people whose disability is due to mental illness. PSDs might be trained to remind patients to take their psychiatric medications, turn on lights for patients with posttraumatic stress disorder (PTSD), or interrupt self-mutilation by patients with dissociative disorder. Under the ADA, service animals can go anywhere the public can go.

Emotional Support Animals

Emotional support animals (ESAs) provide support through companionship. ESAs (generally dogs) have no special training and are not given the same accommodations as service animals. Regulations regarding ESAs are primarily set by individual states, but under the Federal Fair Housing Amendments Act and the Air Carrier Access Act, individuals who meet the proper criteria are entitled to an emotional support dog to assist them with their daily life.

Generally, a regular pet can be an ESA if a mental health professional writes a letter saying that the owner has a mental health condition and needs the animal’s help for their health or treatment.

Disorders that qualify for a PSD or ESA must be specified in DSM-5. Examples of disorders that could qualify a person for a service dog or emotional support animal include the following:

• ADHD

• Anxiety disorders

• Depression

• PTSD

• Bipolar disorder/mood disorder

• Schizophrenia

Risk Management Tips for Letters

• For a PSD

  Determine that the patient is psychiatrically disabled to the degree that the person is unable to perform at least one major life task without assistance of a PSD on a daily basis.

• For an ESA

  • Determine whether an ESA can indeed provide emotional support, but also understand how the animal assists with support.

  • Consider meeting and observing the ESA, especially prior to patients’ airplane travel if they do not have their ESA with them. However, patients’ not bringing their ESA to sessions may be a flag that an ESA is not necessary.

  • Resist classifying different species of animals, such as peacocks, iguanas, pigs, and other unusual animals as an ESA for air travel.

  • State that you are not vouching for the ESA’s behavior, but only how the ESA helps your patient.

• For either a PSD or ESA

  State that your patient has a DSM-5 diagnosis for which the PSD or ESA is a necessary accommodation but do not give your patient’s specific diagnosis. ■

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