Emotional support animals (ESA) are back in the news again. These are animals purported to provide support solely by their presence, in contrast to Service Animals (SA), who have been trained to perform a task for a disabled person. There have been several television stories over the last several days questioning whether the use of and approval process for ESAs is being abused. The television commentators exposed a range of unqualified persons performing overly short evaluations and issuing letters in support of persons having ESAs on airline flights. Other issues raided on television included the possibility of untrained ESAs (predominantly dogs) becoming vicious and/or interfering with the functioning of trained SAs. Some months ago, I wrote a post on this topic and am reposting it in the spirit of the current times. I believe it adds clarity to the issue. Read on.
While waiting to board an airplane from Houston, Texas, to Belize, I met a man who was travelling with his Emotional Support Animal (ESA), a lovely Goldendoodle. In case you're as perplexed as I was, that is a mix of a Golden Retriever and a Poodle. He had a business in Belize and was travelling with the dog, who occupied a window seat with the man on the plane. That got me rethinking the issue of when is your animal a pet and when is it a therapeutic aid, a topic also discussed by Rebecca Clay in an article in the Monitor on Psychology for September 2016. In the mental health area, there are Emotional Support Animals (ESA), Service Animals (SA, including Psychiatric Service Animals), and Animals for Assisted Therapy (AAT). The main distinction is that the ESA provides support by its presence alone while a SA has been trained specifically to perform tasks for someone with a disability, such as reminding them to take their medication or checking a room and turning on lights for a person with anxiety.
Emotional support animals make sense, given the large literature on animals’ ability to reduce human stress and anxiety and provide other health benefits, says psychologist Aubrey H. Fine, Ed.D., a professor of education at California State Polytechnic Institute in Pomona and editor of the "Handbook on Animal-assisted Therapy: Foundations and Guidelines for Animal-assisted Interventions" (2015). Dr. Fine did suggest that some people may be abusing the ESA concept so they can have their pets with them. Individuals can go online, answer some questions, and receive a certification and jacket for their dog. In fact, the issue of need for the ESA is a clinical/forensic question involving determination of mental health disability of the individual as well as demonstrated clinical benefit of having the animal present. The evaluation should be conducted by a licensed mental health professional.
Additionally, there is not much research to support the claim that emotional support animals help people more than traditional pets. This is according to co-authors Cassandra L. Boness, Jeffrey N. Younggren, PhD, a psychology professor at Missouri, and Jennifer A Boisvert, PhD, a private practitioner in Beverly Hills and Long Beach, California (Professional Psychology: Research and Practice, 2016). Their review of the literature revealed little evidence that emotional support animals are effective, The co-authors indicated that "The research we did find was inconclusive".
The certification of ESAs appears to have become a growing industry. There are a number of online commercial entities that specialize in providing SA or ESA certification for dogs and other animals without ever having seen or evaluated a person or their animal. For instance, the United States Dog Registry provides three levels of certification: SA dogs, ESA dogs and therapy dogs. In their advertising, the U.S. Dog Registry states that certification will allow the animal (ESA, SA, or therapy dog) to fly in a commercial airplane for free and will allow the dog in all housing regardless of an existing pet policy.
The media has taken note of the topic of airline accommodations being made for ESAs. In a 2014 New Yorker article titled, “Pets allowed: Why are so many animals now in places where they shouldn’t be?” author Patricia Marks reported that the National Service Animal Registry, a private commercial enterprise that sells certificates, vests, and badges for helper animals, signed up 11,000 animals online in 2013, even though the animals may not have merited certification. In a USA Today (2015) article, the editorial staff took the position that while SAs were acceptable, ESAs infringed on others' rights and reflected an exploitation of law and regulation by animal lovers. The article was critical of how some online commercial entities provide ESA certification. As I noted above, some commercial entities render a letter in support of needing an ESA without a licensed mental health professional seeing or evaluating an individual or their pet in person. There are commercial services specializing in online and telephone disability assessments and offering letters of certification to those thought to qualify.
It is easy to see how an industry has developed around the certification of ESAs, allowing pet owners to have their pets travel on commercial aircraft at no cost. Nonetheless, it is clear to me that these commercial evaluative services are questionable from a professional standards perspective and inconsistent with existent psychological ethics and forensic standards. This media publicity and industry has implications for my fellow psychologists as they might be pressured by patient requests for a letter of evaluation in support of their need for an ESA or certification of their pet. In fact, at a former clinic where I worked, it was not uncommon to have patients requesting such letters from their clinicians.
So what are we to do about all this? It is clear that Service Animals provide specific valuable services. Animals used in Animal Assisted Therapy also provide clear benefit in a carefully planned clinical program. And we all love our pets. But what are we to do about Emotional Support Animals? It would appear that, given the paucity of empirical evidence to support the concept, more careful evaluations are in order conducted in person by licensed mental health professionals. These evaluations would need to meet more specific criteria such as those suggested by attorney John Ensminger and neuropsychologist Dr. J. Lawrence Thomas in Law and Human Behavior in 2013:
1. Confirm that the individual actually has a mental health diagnosis.
2. Explain clearly how the animal helps lessen the severity of the mental health condition.
3. Describe how the individual and animal interact, which assumes that the evaluator meets with both.
4. Explain clearly the possible negative effects of the individual not having the animal with them.
5. Note any training the animal has had from a qualified trainer, if appropriate.
This appears to be an issue gradually getting out of control. What is needed is a mix of compassion as well as evaluations marked by more scientific rigor. This will assist all the travelling public.
Good luck on your journey (and airplane flight) as always.
Dr. Paul Longobardi
For information on these and related topics, please see my website at www.successandmindset.com.