Well, the rise in use of emotional support animals (ESAs) on airlines is once again in the news this week. In the Los Angeles Times business section for August 9, 2019, Hugo Martin wrote an article titled "Certain breeds can’t be barred from flights". He observed that one month after a flight attendant was bitten by an ESA, the US Department of Transportation told the airlines that carriers can’t bar certain dog breeds because airlines deem them dangerous, including pit bulls. Passengers only are required to produce vaccination and training records for their animals. Airlines for America, a trade group for the country’s largest carriers, reported that there have been over one million passengers bringing ESAs on flights last year and that there has been a sharp increase in incidents such as biting and mauling by untrained animals. In the article, it was noted that United Airlines reported a 75% increase in ESAs on flights in 2017 compared with 2016. In an article by Hugo Martin last year, he noted the 84% increase in incidents of urination, defecation and biting by service and support animals during flights on Delta Airlines. He highlighted how airlines are struggling with deciding what additional measures and documentation should be needed to travel with such animals. Federal law from 1986 only says that passengers who rely on such animals to manage anxiety and other mental disorders must be allowed to bring the animals onboard. However, there has been no guidance for procedures for diagnosing the person who claims the need to have the ESA onboard. I shall have more to say about that below. Airlines have taken to introducing some restrictions of their own such as in American Airlines ban of several types of creatures including hedgehogs, goats, ferrets, chickens, birds of prey, and snakes. There has been concern over whether some passengers do not in fact have anxiety, phobias, or panic disorders (among the most common disorders for which such documentation is requested) but rather are trying to get a free ride for their pet. That has spurred some mental health professionals to recommend creation of better standards for determining the need. I began to rethink 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 or assisting a blind person.
Emotional support animals do make potential 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 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 research review showed 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 already had 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 other’s 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. What about people who have anxiety and/or phobias around animals? I have seen many in my career. What are their rights to enjoy their flight in reasonable comfort? This point was noted in the LA Times article as having ESAs on board airlines may exacerbate conditions for people with allergies and/or anxiety around animals. Also, 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 on airplanes? It would appear that, given the lack of research to support the concept, more careful evaluations are in order conducted in person by licensed 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.
What is not discussed is how persons can learn to deal with their anxiety and stress about flying without the need for ESAs. For a complete review of stress management issues, please consult our book (I Can't Take it Anymore: How to Manage Stress so It Doesn't Manage You; Paul G. Longobardi, Ph.D., and Janice B. Longobardi, R.N., B.S.N., P.H.N.) available on Amazon at https://www.amazon.com/dp/1542458056. For details about the book and authors, please consult our website at www.manageyourhealthandstress.com.
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 and consideration of alternative means of helping fliers with stress related conditions balanced against the rights of other travelers.. This will assist all of us as we fly the skies.
Good luck on your journey as always.
Dr. Paul Longobardi
For information on these and related topics, please see my website at www.successandmindset.com.