I must have been living under a rock to not see the skyrocketing trend of emotional support animals (ESA). Across the country patients are using animals from snakes to guinea pigs for emotional support, and expecting to bring these animals everywhere they go, including your medical office.
Emotional support animals are NOT the same as service animals. To be considered a service animal there is significant amount of training required. However, ESAs require no formal training. The only requirements to be considered an ESA seems to be that the animal is domesticated and offers some comfort to their owner. With service animals, it’s the animal that must qualify. In the case of ESAs, it’s the owner who must qualify as having an emotional or mental need for the animal.
Qualifying for an Emotional Support Animal
So, how do you know if your patient really needs their pet snake with them as emotional support, or if they just didn’t want to leave it at home?
If your patient has a medical reason for their ESA, they should have a letter from a licensed mental health professional identifying their need. However, as the interest in ESAs has grown, a variety of sketchy websites have emerged that require patients to answer a few simple questions and pay a fee to receive a less than verifiable ESA letter.
According to psychologist, Aubrey H. Fine, EdD, in an American Psychology Association article, “Emotional support animals make sense, given the large literature of animals’ ability to reduce human stress and anxiety and provide other health benefits. However, Dr. Fine goes on to say, “My concern is some people are misusing this so they can have their pets with them.”
Ultimately, it is difficult to determine if your patients really need their ESA to function, or if they just want to have their animal with them.
ESA Access vs. Service Animals
Both ESAs and service animals can be used to assist patients with their mental health issues. Service animal examples include reminding patients to take essential psychiatric medications or stopping someone from engaging in self-mutilation, whereas ESAs provide comfort and support. Since service animals require more formal training, they are afforded more legal protection.
Unlike ESAs, service animals are granted access to just about everywhere the public can go, according to Title III of the federal Americans with Disabilities Act (ADA) and virtually all state laws. If you fail to allow service animals in your practice (except in disruptive or dangerous situations) you can be hit with a discrimination lawsuit that results in costly awards. However, ESAs do not share this same protection.
If your patient has a letter from a licensed mental health professional stating their need for an ESA, this only has two federal protections: (1) Airlines are required to allow ESAs to fly for free in the cabin with their owners; (2) Landlords are not allowed to exclude ESAs. Also, It’s important to note that there are several states that have protections in place for ESAs beyond these two items, so you must know your state laws to ensure compliance.
To Allow Emotional Support Animals or Not
You don’t really have a choice as to whether you allow service animals into your practice, as they are protected by the ADA. This doesn’t mean you can’t ban a specific service animal from your practice if it is disruptive or dangerous. What it does mean is that you can’t ban ALL service animals.
Currently, only dogs and miniature horses (yes, miniature horses) are categorized by the ADA as service animals. In contrast, a patient can claim ANY domestic animal from a rat to a python as an ESA. Depending on the animal, this has the potential to cause you a variety of problems. What if another patient is petrified of snakes or allergic to cats? How should you deal with these situations to consider all of your patients’ needs?
To start, it’s helpful to have a clear ESA policy in place. You should notify your patients about your ESA policy, and train your staff on how to comply with it. Also, it’s helpful to train your staff on how to discuss this delicate issue with your patients. Then, you must be able to determine whether your patient really depends on the ESA for wellbeing, or if it’s just a pet. There are two indicators you can use:
- ESA: Your patient should have a formal letter they can show you that has been written from a licensed mental health professional identifying their emotional or mental need for an ESA.
- Service Animal: Ask your patient to identify the work or tasks their service animal has been trained to perform. If your patient can’t answer, it’s most likely is not a real service animal.
The decision to allow or ban ESAs from your practice is ultimately yours, but it isn’t a decision you should make lightly. As the number of patients with ESAs continues to grow, so does the impact of your decision. Allowing ESAs could certainly upset other patients and cause disruption in your waiting room. Banning them altogether could lead to negative publicity and damaging online comments that could significantly hurt your reputation and ability to get new patients. Unfortunately, there is no easy answer.
To learn more about how to determine if you should allow ESAs, what to include in an ESA policy and how to implement it, you can check out this online training: https://healthcare.trainingleader.com/product/emotional-support-animal/
Here is some additional ESA information that might be helpful to you:
- American Psychological Association article: ? https://www.apa.org/monitor/2016/09/pet-aid
- US Department of Justice: https://www.ada.gov/regs2010/service_animal_qa.pdf