Five Things Healthcare Students Should Know About Emotional Support Animals

From child-biting dogs to peacocks named Dexter to wrongly flushed hamsters, emotional support animals (ESA) have been in the news a lot lately. With so much (and sometimes negative) buzz, future healthcare professionals may be trying to sort fact from fiction when it comes to ESAs and what they offer. Read on for a roundup of five helpful things to know about emotional support animals.

1. ESAs are nothing new.

While ESAs may be eliciting significant buzz in 2018, they’re origins date back more than a hundred years. Seeing eye dogs officially appeared on the scene following WWI, and since that time dogs and many other kinds of animals have been trained to provide help for people with disabilities, including blindness, deafness, seizures, and other physical ailments. At the same time, the animals were providing love and support for their owners -- and thus the concept of support animals was formed.

Wondering about the difference between emotional support animals, therapy animals, and psychiatric service animals? Explains PetMD, “A psychiatric service animal is trained to aid a person who has an emotional or mental disability that gets in the way of the completion of necessary life tasks. Therapy animals are mainly used to provide comfort and security, such as those that visit hospitals, nursing homes, and schools. An emotional support animal is “prescribed” by a mental health professional through a fairly rigorous process. A licensed therapist needs to submit a letter outlining a client’s condition as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM IV and DSM V).”

2. Their legal status is limited.

The Americans with Disabilities Act (ADA) is designed to protect the rights of individuals with disabilities by addressing and eliminating major areas of discrimination against them. Under the ADA service animals are defined as “dogs that are individually trained to do work or perform tasks for people with disabilities.”

Furthermore, the ADA specifies, “Service animals are working animals, not pets. The work or task a dog has been trained to provide must be directly related to the person’s disability. Dogs whose sole function is to provide comfort or emotional support do not qualify as service animals under the ADA.”

In other words, the ADA does not include provisions for emotional support animals besides dogs. Because ESAs are legally viewed as pets, they’re without many of the protections provided to service animals.

3. The science is murky.

While people swear by the ability of ESAs to reassure, calm and soothe, researchers aren’t yet ready to sign off on them as a method for reducing psychological distress in practice. Concludes an article published in the Journal of Clinical Psychology, “The evidence suggests that human-animal interaction (HAI) has a small-to-medium effect on distress but does not clarify whether animals account for the treatment effects. Research also has not determined whether positive effects observed in circumscribed HAI programs extend to companion animal ownership.”

In fact, some researchers have fears that ESAs may ultimately do more harm than good. Yale Psychology researcher Molly Crossman told Vox, “Basically, in treatments for anxiety that work, we ask people to face their fears. We work with them to gradually approach the things they’ve avoided. These treatments work really well. They’re some of sort of the best mental health treatments that we have. A concern we have in those kinds of treatments is that people will feel like, ‘I can only approach this terrifying situation if they have my mom with me, or my blankie,’ or whatever. If someone who’s very afraid of heights is only able to approach heights with their emotional support dog, they might start to say, ‘Wow, I can do this because of Buddy.’ We want you to learn you can do it, and we don’t want it to be about Buddy.’”

4. Healthcare professionals play a big role.

With the majority of the controversy over ESAs focused on air travel, it’s worth noting that health care providers may be the most important factor in determining whether or not a particular pet qualifies. Under the federal Air Carrier Access Act (ACAA), passengers seeking to travel with either an emotional support or psychiatric service animal may be required to provide documentation from a licensed mental health professional.

The ACAA further clarifies that airlines aren’t required to accommodate “certain unusual service animals (e.g., snakes, other reptiles, ferrets, rodents, and spiders) as service animals in the cabin,” and may also prohibit animals based on other factors, such as size, whether they will cause a cabin disruption, and the laws of the destination. The takeaway? Even with a doctor’s note, non-dog ESAs may not be allowed on flights if they don’t meet certain airline-determined qualifications.

5. Healthcare practitioners are also torn on the topic.

It’s not just researchers wrestling with the ESA issue. According to research published in Professional Psychology: Research and Practice as reported by Reuters, while 31 percent of surveyed mental health practitioners had recommended ESAs to patients, 36 percent didn’t feel qualified to make these recommendations, including two who had already done so. Dr. Paul Cherniack told Reuters, “I believe there is no evidence yet that emotional support animals benefit people’s health. Other service animals like seeing eye dogs are different.”

This controversy is putting therapists -- who are being increasingly asked for letters -- in a complicated ethical position.

While the verdict may still be out regarding the true impact of ESAs, the first-hand evidence is compelling. In bringing comfort farm animals to Stoneman Douglas students on their return to school last week following the mass shooting, Michelle Alvarez told NBC Miami, “We know the feelings and the happiness that these animals bring to all of us, we just wanted to come today and spread some love.”