What Should We Do About Emotional Support Animals?

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Physicians are being asked for Emotional Support Animal (ESA) documentation letters more than ever before. As landlords and airlines become more savvy about the scam letters patients can purchase for $150 on the internet, patients increasingly lean on their physicians to outline their disabilities and benefits of an ESA to comply with the Fair Housing Act and the Air Carrier Access Act.

Patients are well aware of the cost-savings of carrying their pet in the cabin of the airliner rather than relegating an animal to the cargo-hold as “checked baggage.” They also avoid pet damage deposit fees in “no-pet” housing situations — an ESA letter means “economic support” as well.

Some physicians and psychotherapists are choosing to not provide the documentation when requested, running the risk of a disability discrimination complaint. In fact, physicians aren’t trained to assess whether a particular animal (or species) would be best for a particular patient, so we are essentially writing a “blank script” that the patient then fills in themselves.

Particularly in college campus dormitories these days, there are far more than two-legged mammals inhabiting dorm rooms. Over 30% of college students now have a mental health diagnosis, making them eligible for an ESA, and these students are exercising their civil rights along with their animals. It isn’t always dogs they bring from home: there are cats, rats, hamsters, guinea pigs, flying squirrels and ferrets, as well as pot bellied pigs, tarantulas and a variety of birds. Oh, and a snake.

And you thought dorms didn’t smell great back in your college days.

Only a small minority of these animals have any training as an actual service animal, with the legal right to accompany their owner to classes, public transportation and dining halls.

The vast majority of these animals are emotional support for housing purposes only, yet they regularly show up in public buildings, classrooms and grocery stores, often dressed in internet-purchased jackets labeled as a “therapy or service” animal. Suddenly, ESAs have become a (barely) tolerated part of the community landscape.

As a physician as well as a farmer who has owned a variety of pets over the years, I am deeply concerned about evidence-based care and stewardship of my patients, but I also have compassion for animals who would never choose to live out most of their lives in a kennel or crate in a tiny dorm room.

I missed my pets during the thirteen years I was pursuing education and training, but I knew I didn’t have the time, money, space or desire to expose an animal to a schedule and environment that I could barely tolerate myself. That realization is not stopping the distressed college student of today from demanding they be able to keep their animals with them in their stress-mess.

As a clinician working with many anxious and depressed patients, I’d much prefer writing fewer pharmaceutical prescriptions and instead strive toward finding non-medicinal ways to address their symptoms. I’d like to see my patients develop coping skills to deal with troubles that come their way and hone resilience to pick themselves up when they feel knocked down. I would hope they could see themselves as part of a diverse community, where their actions have ripple effects on those living, working, eating, riding and studying around them. Animals in the community can adversely affect others if not well-trained, particularly those with severe allergies or phobias.

Yet I regularly find myself reluctantly writing a “prescription” for a living, breathing creature perceived by the law as a “treatment” rather than as a profound responsibility taken on by disabled owners for the lifetime of their animal. I’ve always wondered whether it really should be an animal’s job to provide “emotional support” for a human — rather, our lives are given additional meaning when we care for something or someone beyond ourselves.

The emotional support part of an ESA really should be about the well-being of the animal, not about us.

Emily Gibson, MD, is a board-certified family physician and the director of the Student Health Center at Western Washington University. She is a 2018–19 Doximity Author.

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