Tuesday, April 4, 2023

Patient Asks You to Certify Emotional Support Animal: What Should You Do?

Multiple studies show the mental health benefits of pet ownership. What’s less clear from a small number of studies is the clinical benefits that emotional support animals offer for patients with psychiatric symptoms. An article in Psychiatric Services explores several factors psychiatrists should consider when asked by patients to write certification letters designating their pets as emotional support animals.

“ESAs [emotional support animals] are different from service animals and other disability-related assistance animals,” wrote past APA president Reneé Binder, M.D., of the University of California, San Francisco, and colleagues. Emotional support animals can be “animals of any species that alleviate symptoms of a person’s psychiatric disability through their companionship or presence but do not perform a specific task [as service animals do].” Also, unlike service animals, these animals are not protected by the Americans With Disabilities Act, but are regulated by various federal, state, and local laws, Binder and colleagues noted.

The authors described language in the following federal laws regarding emotional support animals:

  • Americans With Disabilities Act
  • Fair Housing Act
  • Air Carrier Access Act
  • Individuals With Disabilities Act

“Although federal statutes set minimum requirements protecting individuals with disabilities, state or local policies can require additional accommodations for people with disabilities,” the authors continued. “When assessing a patient’s eligibility for an ESA, clinicians must be aware of state and local laws that are constantly evolving and specific to a jurisdiction.”

More than one-third of mental health providers report feeling unqualified to determine whether to certify an emotional support animal, the authors continued. While there are few formal training opportunities for psychiatrists interested in ESA certification, “several authors have recently proposed practice guidelines for mental health providers to determine whether patients would benefit from an ESA,” they wrote. To start, they advised psychiatrists to do the following:

  • Determine whether a patient has a chronic mental impairment caused by a psychiatric condition (as defined by the DSM-5-TR) that substantially limits functioning in one or more domains.
  • Determine whether the ESA will alleviate such an impairment.

Additionally, they advised psychiatrists to consider a patient’s ability to care for an animal, as well as the animal’s ability to serve in the role as an emotional support animal.

Other topics explored in the article include ethical considerations, inappropriate ESA letters, and liability of the ESA letter writers.

“We recommend clinicians think about the evidence and considerations presented in this article before determining whether they want to complete an ESA letter for a patient. It is ethical and may be clinically indicated for clinicians to decline to write such letters,” the authors concluded.

For related news, see the Psychiatric News article “What to Do If Patients Want Service or Emotional Support Animals.”

(Image: iStock/vitapix)

What’s Your Experience With Telepsychiatry? APA Wants to Know

APA is continuing to advocate for changes to improve the practice of psychiatry and we need to hear from you to better understand how you use telepsychiatry technologies. Unidentified aggregated data will be shared with the Centers for Medicare and Medicaid Services (CMS) as it promulgates rules that impact psychiatry.



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