Why therapists shouldn't approve their own patients' emotional support animals

A growing number of therapists are certifying their patients' pets as emotional support animals.

Emotional support animals do not have any training requirements under U.S. law

A curious dog checks out the camera during a therapy dog session at the University of Regina on Nov. 22, 2016. (Micki Cowan/CBC)

 A growing number of therapists are certifying their patients' pets as emotional support animals, allowing people to take their cats, pigs and birds on planes and into rental homes even though it may not be medically necessary, a recent study suggests.

Researchers asked 87 mental health professionals to review current laws and policies for determining when animals may qualify as emotional support animals in the U.S., including federal transportation requirements for air travel. Then, researchers questioned these professionals about how support animals should be certified.

Overall, about 31 per cent of the survey participants said they had previously recommended emotional support animals for people. However, 36 per cent of them said they didn't feel qualified to make these recommendations, including two practitioners who had done so in the past.

Study co-author Jeffrey Younggren of the University of Missouri explained the difference between service animals and emotional support animals.

I believe there is no evidence yet that emotional support animals benefit people's health.- Dr. Paul Cherniack

"Service animals are formally trained to perform specific healthcare duties/function and their training matches the patients' needs and they are not considered pets," he told Reuters Health by email. "This is a formal process."

"However, emotional support animals do not have any training requirements under the law nor are these certifications limited to dogs," Younggren said. "Ducks, turkeys and potbelly pigs have all been certified by somebody as emotional support animals."

Unconditional support

Federal and state laws regulating emotional support animals (ESAs) often are convoluted and constantly changing, Younggren and his colleagues note in a report of their study, which is scheduled for publication in the journal Professional Psychology: Research and Practice.

For example, landlords who normally prohibit pets must allow ESAs and waive any fees or pet deposits.

Airlines are required to allow ESAs to accompany their owners in the main cabins of aircraft.

The mental health professionals in the survey believed certifying emotional support animals can sometimes be appropriate, the survey found.

In this 2016 photo, medical assistant Eloise Olmos pets Dallis the Westie at Rush University Medical Center in Chicago, which offers monthly sessions with animals. (Carrie Antlfinger/Associated Press)

But to sidestep potential legal and ethical problems, clinicians should not certify animals for patients they are already treating, the researchers argue. Mental health professionals who work in courts of law and who don't have a prior relationship with a patient may be better able to make an impartial decision on whether an emotional support animal might actually benefit that person.

These evaluations should be done with the same thoroughness and impartiality that is found in evaluations for any disability, the researchers also argue. This may require the development of professional guidelines for what assessments are done, who conducts them and how they are completed.

Many mental health professionals may not understand that a conflict of interest exists when a patient asks for an animal to be certified because they want to make the patient satisfied and keep the patient engaged in therapy, said Dr. Paul Cherniack, a researcher at the University of Miami Miller School of Medicine who wasn't involved in the study.

Another issue is that clinicians may rely on subjective reports from patients about how animals help them, especially in the absence of objective ways to measure the therapeutic benefits of these animals, Cherniack said by email.

"I believe there is no evidence yet that emotional support animals benefit people's health," Cherniack said. "Other service animals like seeing eye dogs are different."

While better guidelines and standards for certifying emotional support animals is needed, there is some evidence to suggest that pets do have the potential to comfort people with mental health problems, said Dr. Helen Brooks of the Mental Health Research Group at the University of Manchester in the UK.

"Pets helped their owners manage feelings by distracting them from symptoms and upsetting experiences such as hearing voices and suicidal ideation and provided a form of encouragement for activity," Brooks said, who wasn't  involved in the current study, said by email. "Pets provided secure relationships and unconditional support which were often not available elsewhere."