Navigate patient requests for an emotional support animal

When Serena-Lian Sakheim-Devine’s childhood best friend died of cancer, she felt sad and lonely in college. Wanting something warm to cuddle, she took a guinea pig and named it Basil. Then she got two more and called them Nutmeg and Paprika. The three became his Spice Girls.

“They were a great comfort to me, but also to others in times of need,” said Sakheim-Devine, 26, who lived with them in a dormitory at Smith College, a women’s institution in Northampton, Massachusetts.

Her therapist wrote a letter and sent it to Smith’s Office of Disabilities, which licensed the guinea pigs as emotional support animals (ESAs). Eventually, however, she wanted a dog to help her manage her post-traumatic stress disorder, depression, anxiety, and panic attacks. So she adopted a beagle from a shelter.

Once again a therapist provided a letter and Sakheim-Devine was allowed to keep the beagle, Finnian, then about 13 years old, in her dorm on the condition that she give up the guinea pigs, which she did. fact.

She and Finnian bonded almost instantly. When she woke up drenched in sweat, unable to move or speak, the dog felt how tense she was. Finnian licked his hands, wiggled his fingers, and helped anchor him.

“I didn’t really teach her that. She just knew,” said Sakheim-Devine, now a security engineer who lives in New Haven, Connecticut. “It was amazing how connected we were, even from the start.”

The therapeutic benefits of four-legged friends

Although there is little scientific literature on the therapeutic use of ESAs, there are well-established benefits of having pets that also apply in these situations. Animals can distract from stress, alleviate loneliness and instill a sense of responsibility, said Rachel A. Davis, MD, associate professor of psychiatry and neurosurgery at the University of Colorado’s Anschutz Medical Campus in Aurora, Colorado.

They add structure to a person’s day by needing to be fed at specific times, and they can help the human exercise. “Patients reported improved sense of life and purpose,” Davis said.

A mental health clinician may recommend ESA to help alleviate symptoms of mental illness-related disability, as described in the Diagnostic and Statistical Manual of Mental Disorders. Examples include depression, anxiety, obsessive-compulsive disorder, panic attacks, and post-traumatic stress disorder.

ESAs differ from psychiatric service animals, which are trained to perform specific tasks, such as applying deep pressure that calms the owner. By their mere existence, ESAs provide emotional benefits to a person with a mental disability.

“Social support, even from an animal, can really help people feel less alone, better about themselves, and more secure from unpleasantness or even physical attack,” said David Spiegel, MD, professor and associate director of psychiatry and behavioral sciences and director of the Center on Stress and Health at Stanford University School of Medicine in Palo Alto, California.

Write a letter on behalf of your patient

Writing a letter that serves as evidence of a person’s need for CSA is a request that mental health professionals sometimes receive from patients. The letter may grant access to housing at no additional cost, regardless of no-pet policies, and some employers may allow an ESA at work as a reasonable accommodation for a psychological disability. Until recently, an ESA could accompany its owner on a plane, but most airlines no longer allow this, in part because some passengers falsely claim their pets are ESAs.

Before drafting a letter for someone with an ESA, Spiegel asks the patient’s permission to elaborate on the clinical condition that merits professional help and to explain how the animal relieves associated symptoms.

The Fair Housing Act, a federal law, requires a landlord to provide reasonable accommodation involving emotional support or a service animal. Such accommodation honors a request to live on the property despite a no pets policy. It also waives a pet deposit, fee or other rules involving animals on the premises.

Landlords are generally supportive of seeking ESA clearance, said Jonathan Betlinski, MD, associate professor and director of the division of public psychiatry at Oregon Health and Science University in Portland. None of his patients encountered any difficulties once they got a letter from him.

However, “anytime someone asks me for a letter for an ESA, that’s the time to have a conversation. It’s not automatic,” Betlinski said. The discussion involves inquiring about the type of pet a patient has and how it helps their emotional state.

For confidentiality reasons, Betlinski does not disclose the specific diagnosis in the letter unless the patient signs an informational release. ESA laws only require that their letter state that an individual has a qualifying diagnosis and that an ESA helps improve symptoms, but it is not necessary to explain how.

“You can see how writing the letter is a balancing act,” he said. But he finds it helpful to mention any training the animal has had, such as the Canine Good Citizen course sponsored by the American Kennel Club.

Most of the letters that Luis Anez, PsyD, a clinical psychologist and associate professor of psychiatry at Yale University School of Medicine in New Haven, Connecticut, wrote for this purpose were in favor of AES in housing. But he also recalled providing a letter to a patient who was traveling to Puerto Rico with an ESA. Letters are generally only provided to established patients with psychiatric diagnoses.

Without a letter, “We’ve seen people say, ‘I’d rather be homeless than part with my dog,'” said Anez, who is also director of Hispanic Services at the Connecticut Mental Health Center, a partnership between Yale and Connecticut. Department of Mental Health and Addiction Services in Hartford. Before obtaining an ESA, Anez recommends that individuals become familiar with their owner’s policies regarding any dog ​​size and breed restrictions.

Additional Considerations

An ESA doesn’t have to be a dog. “It could definitely be a cat. It could also be a parrot,” said Stephen Stern, MD, a psychiatrist in private practice in Mount Kisco, New York. But, “if they say their emotional support animal is an earthworm, that would make you think,” he added half-jokingly.

Stern only writes an ESA letter for a patient with whom he has an ongoing professional relationship. For example, if he is treating someone for depression and that patient tells him how the animal helps relieve the symptoms, then that is sufficient justification to write a letter.

“Because you know them, you’ve assessed what they’re saying is plausible,” said Stern, who is also an assistant professor of psychiatry at the University of Texas Health Science at San Antonio, where he conducted research on companion dogs for veterans with post-traumatic stress disorder and continues to collaborate with colleagues via email and Zoom.

While veterans benefit from ESAs, some live in housing that doesn’t allow pets, said Beth Zimmerman, founder and executive director of Pets for Patriots, a nationwide nonprofit in Long Beach, New York, which partners with animal shelters and humane groups. adopt dogs and cats for companionship and emotional support. She said an ESA can be “a wonderful complement to other forms of therapy a veteran may undertake.”

“A lot of the time when the veteran has a problem, it’s because the landlord is misinformed about the law,” Zimmerman said. “We provide information to the veteran to share with the property owner or management, and always recommend a very friendly approach. In our experience, with very rare exceptions, once the owner understands his responsibilities under the law, he will allow the veteran to have this emotional support animal in his living quarters.”

For Kristin Lowe, a chocolate Labrador-Weimaraner mix named Lola provided emotional support from her puppy days until her death at the age of 12 last May. Lowe’s psychiatrist provided letters that allowed Lola to live in his apartment and travel on commercial flights.

“She was so connected to me,” said Lowe, 34, who lives in Denver and works as a physical therapy administrative clerk. “She was part of me. She could read every emotion I had.”

Now Lowe is counting on Henry, an Australian Shepherd puppy, to help him cope with obsessive-compulsive disorder, major depressive disorder and an eating disorder. She described him as “a very happy little guy and a constant bustle – and that kindles something in me”.

More information, which is provided by the US Department of Housing and Urban Development, can be found here.

Susan Kreimer is a New York-based freelance health journalist.

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