Emotional support animals

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Everyone I know who has one, or even asks for one has said, "I know this is completely bogus, but I really want to bring spot with me." So then we have a credibility decision to make. This is most often a way to force land lords to accept pets. The only way support pets help patients is by coping with rental restrictions.
 
MacDonaldTriad said:
Everyone I know who has one, or even asks for one has said, "I know this is completely bogus, but I really want to bring spot with me." So then we have a credibility decision to make. This is most often a way to force land lords to accept pets. The only way support pets help patients is by coping with rental restrictions.
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I agree. The first few times a patient asked me for this, I thought they were being sincere and just assumed I had missed a personality disorder diagnosis. Then I talked to a friend of mine who said he's approached people in airports who had dogs with them which were obviously not service animals, asked them "excuse me, do you mind if I ask how you're able to get the airline to allow your dog in the cabin with you?" and without fail, their reply was "oh, it's really easy, you just ask your doctor for a letter saying it's an emotional support animal!"

Fortunately, unlike the whole adult ADHD thing, this is one issue on which so far I've been able to get away with simply saying "sorry, I don't do that."
 
They can, and maybe should, just have a pet. It has benefits. However, taking your pet with you everywhere is indicative of some type of pathology that you are not addressing/treating, IMHO.

As an aside, I have often said I do not feel comfortable violating the rights of one because of the pathology of another. Landlords, for example, bar animals from their personally owned property for a legitimate and understandable reason (usually financial risk). Who the hell am I to overrule their business practices?! I'm not a lawyer. I don't feel comfortable with that kind of power and would not appreciate if someone else did that to me/my business.
 
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Regarding this topic, if the patient is requesting a Dog Breed such as (Rottweiler, Pitbull or German Shepard), can I refuse to write the letter? I don't feel comfortable with the liability it would pose if the dog were to bite a child, for instance, on a plane?
 
shahseh22 said:
Regarding this topic, if the patient is requesting a Dog Breed such as (Rottweiler, Pitbull or German Shepard), can I refuse to write the letter? I don't feel comfortable with the liability it would pose if the dog were to bite a child, for instance, on a plane?
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There is no liability. You aren’t writing for the animal but for the patient. It is the airline that would be liable they are still supposed to exercise care in deciding what animals to let on. You are merely expressing your opinion that the patient needs an ESA. Personally I don’t write ESAs for flying only housing.
 
I should probably develop a better way to address this issue, but I explain to them that all I do is write a letter that states they feel they get benefit from an animal and leave it at that — with no recommendations — then inform them that whatever decision a landlord has to make is up to them.

“To whom it may concern:

_____ is a patient under my care. They have an animal that they feel is beneficial to the conditions for which they’re being treated. Your consideration is appreciated.”
 
erg923 said:
They can, and maybe should, just have a pet. It has benefits. However, taking your pet with you everywhere is indicative of some type of pathology that you are not addressing/treating, IMHO.

As an aside, I have often said I do not feel comfortable violating the rights of one because of the pathology of another. Landlords, for example, bar animals from their personally owned property for a legitimate and understandable reason (usually financial risk). Who the hell am I to overrule their business practices?! I'm not a lawyer. I don't feel comfortable with that kind of power and would not appreciate if someone else did that to me/my business.
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The apartment issue is one that hits too close to home for me to be objective on. I currently live in an apartment and the neighbor below me has a dog who barks incessantly, when presumably they're not even home, and it's a deep-voiced bark that bellows through the floor.
 
My lay opinion is that there is no such thing as a dog that doesn't demand a good deal of work and attention. So it's hard to see any dog as a crutch against a healthier, more active, involved life. It's not as if the dog is bringing someone a cup of tea while they linger in bed.
 
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st2205 said:
I should probably develop a better way to address this issue, but I explain to them that all I do is write a letter that states they feel they get benefit from an animal and leave it at that — with no recommendations — then inform them that whatever decision a landlord has to make is up to them.

“To whom it may concern:

_____ is a patient under my care. They have an animal that they feel is beneficial to the conditions for which they’re being treated. Your consideration is appreciated.”
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That's my approach as well. It's something of a cop-out, but it's a good compromise of not pissing a patient off while retaining some shred of my own self-respect.
 
At least in the ways that they are training some "support" animals for things like PTSD, they are actually hindering treatment gains. One interview I saw of someone who trains dogs for VA patients raved about how they train the dog to engage in checking behaviors and such. Essentially, they're just benzos with fur, further ingraining the pathology and making it harder to dislodge with actual treatment.
 
Lately I have been kicking these to primary care same as I would for prescription medications. “I’m sorry, I don’t prescribe medications or animals.” This is mainly just an avoidance on my part. Maybe I could get an animal trained to tell patients No when I don’t want to.
 
In the big scheme of things I have just given up on fighting over ESAs. I just ask our clinic SW to draft the letter and I sign it.

I think most of the requests are complete nonsense and simply attempts to get their critter to fly on a trip or get into an apartment for free, but I have bigger fish to fry and don’t want to ruin the therapeutic alliance over something so trite.

But a piece of me dies with every one of these letters I sign.
 
WisNeuro said:
I think the problem is, at least in some cases, that it isn't benign, and actually has a negative effect treatment progression. But, maybe that's just the cynical part of me who has a lot of experience in the VA system.
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It is another symptom of our society's dysfunction. The VA is just a microcosm of the whole so it can be easier to see. The disability compensation, need for medications, dependency, and entitlement parade keeps growing. In the poker of online forums, I will match your cynicism and then raise it.
 
MacDonaldTriad said:
Everyone I know who has one, or even asks for one has said, "I know this is completely bogus, but I really want to bring spot with me." So then we have a credibility decision to make. This is most often a way to force land lords to accept pets. The only way support pets help patients is by coping with rental restrictions.
Click to expand...
It seems to me that almost all apartments allow pets. My college age son is truly afraid of dogs and among 80 apartment complexes near his college campus only 2 stated a no pet policy, but they are required to allow service dogs. We thought that would be great until his apartment turned out to be between 2 tenants with dogs. One said "I'm just dog sitting it for a friend". I turned her in, dog was gone in one day. The other, who clearly did not need a service dog, claimed he was "training it as a service dog for my little cousin, who is blind". Hmm. But you don't need a service dog. The apartment manager allowed him to keep it. At least it was quiet and well trained and always on a leash. This didn't help my son who cringed every time he saw it in the hallway. But hey, they are not required to take phobias into consideration for tenants.
Yes, I have a pet peeve about this (puns always intended). Yes, I do stand up for my kid when he needs it. No, I don't think your pet enjoys getting on that airplane with you.
Rant over. My proposal for emotional support animal: tried and true and will never bite anyone: 914blLD4RCL._SY355_.jpg
 
smalltownpsych said:
It is another symptom of our society's dysfunction. The VA is just a microcosm of the whole so it can be easier to see. The disability compensation, need for medications, dependency, and entitlement parade keeps growing. In the poker of online forums, I will match your cynicism and then raise it.
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Honest question. Do you believe that most psychiatric illness in general is a manifestation of our society being poorly suited to fit our needs as human beings? Or is it inherent to our biology? I just find it hard to believe that we could evolve to have such high rates of depression and crippling anxiety.
 
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wysdoc said:
My proposal for emotional support animal: tried and true and will never bite anyone:View attachment 231593
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I would rather be an jerk with an animal on a plane than be accused of having a positive Teddy Bear sign. Grown ups with Teddy Bears is pathognomonic for cluster B. Most pets on airplanes I see usually come along with a few family members. Really, your wife or your father isn't sufficient so you need a pet in addition?
 
MacDonaldTriad said:
I would rather be an jerk with an animal on a plane than be accused of having a positive Teddy Bear sign. Grown ups with Teddy Bears is pathognomonic for cluster B. Most pets on airplanes I see usually come along with a few family members. Really, your wife or your father isn't sufficient so you need a pet in addition?
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On the long-term monitoring unit for epilepsy, there were 2 almost sure signs that someone had psychogenic seizures and/or was going to fail our validity testing on cognitive measures; the teddy bear sign, and the bible study sign.
 
wysdoc said:
It seems to me that almost all apartments allow pets. My college age son is truly afraid of dogs and among 80 apartment complexes near his college campus only 2 stated a no pet policy, but they are required to allow service dogs. We thought that would be great until his apartment turned out to be between 2 tenants with dogs. One said "I'm just dog sitting it for a friend". I turned her in, dog was gone in one day. The other, who clearly did not need a service dog, claimed he was "training it as a service dog for my little cousin, who is blind". Hmm. But you don't need a service dog. The apartment manager allowed him to keep it. At least it was quiet and well trained and always on a leash. This didn't help my son who cringed every time he saw it in the hallway. But hey, they are not required to take phobias into consideration for tenants.
Yes, I have a pet peeve about this (puns always intended). Yes, I do stand up for my kid when he needs it. No, I don't think your pet enjoys getting on that airplane with you.
Rant over. My proposal for emotional support animal: tried and true and will never bite anyone:View attachment 231593
Click to expand...
Was he mauled by a dog? Or are you from a dog-phobic culture?

I had a friend who was about 6'5" about 300 lbs and he came over to my house. He was terrified of my dog who was about 40 lbs and said, "That dog is HUGE." It turned out it was his Korean heritage that had conditioned him to be afraid of dogs (he immigrated at about age 12). I had the same experience when I lived in Sweden with a friend who was recently from China who was deathly afraid of dogs.

On the other hand, I have a friend who is a complete dog lover who WAS mauled by a dog as a child. She got a huge payout that was put away for her college tuition, so I think it ended up being a net benefit. No lasting trauma and a big boxer-lover.
 
birchswing said:
Was he mauled by a dog? Or are you from a dog-phobic culture?

I had a friend who was about 6'5" about 300 lbs and he came over to my house. He was terrified of my dog who was about 40 lbs and said, "That dog is HUGE." It turned out it was his Korean heritage that had conditioned him to be afraid of dogs (he immigrated at about age 12). I had the same experience when I lived in Sweden with a friend who was recently from China who was deathly afraid of dogs.

On the other hand, I have a friend who is a complete dog lover who WAS mauled by a dog as a child. She got a huge payout that was put away for her college tuition, so I think it ended up being a net benefit. No lasting trauma and a big boxer-lover.
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Knocked down by a dog while biking when younger, it affected him.
 
Where I live, the culture has become bizarrely dog-positive; dogs go everywhere and people expect you to put up with behavior from dogs that would never be tolerated from human children. I don't mind dogs but I'm intensely allergic to them and it really annoys me when people routinely assume that everybody loves Fido. This is doubled when Fido is the size of a pony.
 
SeniorWrangler said:
Where I live, the culture has become bizarrely dog-positive; dogs go everywhere and people expect you to put up with behavior from dogs that would never be tolerated from human children. I don't mind dogs but I'm intensely allergic to them and it really annoys me when people routinely assume that everybody loves Fido. This is doubled when Fido is the size of a pony.
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There are two kinds of people in this world. Cat People. And idiots.
 
MacDonaldTriad said:
I would rather be an jerk with an animal on a plane than be accused of having a positive Teddy Bear sign. Grown ups with Teddy Bears is pathognomonic for cluster B. Most pets on airplanes I see usually come along with a few family members. Really, your wife or your father isn't sufficient so you need a pet in addition?
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100% positive Teddy Bear sign. And anecdotally from my experience in an affluent area PHP program where they were allowed to bring them, there seemed to be an immense payoff to be able to say "no you can't pet them they are working". I love my dogs and cat, in fact they sleep in our bed but I'm not going to force them to tolerate a plane ride or infringe on the rights of those who don't like animals. Then again I don't really appreciate people flying with babies or young children either. Just say NO. My bottom line: waivers for therapy animals will not be provided until the ADA institutes training requirements.
 
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DoctwoB said:
Honest question. Do you believe that most psychiatric illness in general is a manifestation of our society being poorly suited to fit our needs as human beings? Or is it inherent to our biology? I just find it hard to believe that we could evolve to have such high rates of depression and crippling anxiety.
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Short answer - sort of yes. 🙂

The more true answer is that mental illness has always been with us and we are probably doing better these days with more severe mental illness than we have in some ways in the past. A monthly injection of Invega is better than trephination any day of the week. The fostering of dependency is something newer that is also a side effect of caring for the disabled as opposed to leaving them to fend for themselves. We are also struggling as a culture with acceptance of tradition verses acceptance of diversity. See Tevayeh in Fiddler on the Roof for more about that one. The family and culture are protective factors. Loss of extended family and disintegration of intact family and cultural connectivity are risk factors along with genetic or inherent biological factors. Most of my patients function as expected given their circumstances. Our work is to try to go against that.
 
splik said:
There is no liability. You aren’t writing for the animal but for the patient. It is the airline that would be liable they are still supposed to exercise care in deciding what animals to let on. You are merely expressing your opinion that the patient needs an ESA. Personally I don’t write ESAs for flying only housing.
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I am surprised that you think this practice isn't maladaptive. What kind of benefit does a patient get from using an animal as a way of escaping their scary feelings? Doesn't that just reinforce the false believe that said feelings are dangerous or that the person is unable to deal with them? Seems to me that it's little more than classic avoidance.
 
smalltownpsych said:
Maybe I could get an animal trained to tell patients No when I don’t want to.
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Not a bad idea. I'm envisioning a big German Shepherd or Rottweiler, trained to start growling whenever someone requests a controlled substance.
 
Trismegistus4 said:
Not a bad idea. I'm envisioning a big German Shepherd or Rottweiler, trained to start growling whenever someone requests a controlled substance.
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“But doc, you don’t understand, I need my adderall and xanax for my mental illness. How else am I going to stand sitting home all day doing nothing productive with my life.”
dog-growling.jpg
 
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Lev0phed said:
I am surprised that you think this practice isn't maladaptive. What kind of benefit does a patient get from using an animal as a way of escaping their scary feelings? Doesn't that just reinforce the false believe that said feelings are dangerous or that the person is unable to deal with them? Seems to me that it's little more than classic avoidance.
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petting cats is a DBT skill. petting said cat as a way to use your senses to help regulate your emotions is adaptive. using a dog to scan the perimeter because of your PTSD related hypervigilance is maladaptive. finding the company of an animal therapeutic, healing and restorative is adaptive. not being able to go anywhere without said animal is maladaptive.
 
wysdoc said:
probably going to seek that out once he graduates from college (one more semester)
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Ok good. I was a little worried that you, as a mental health professional, would be reinforcing his fears and allowing him to get away with just running away from dogs.
 
wysdoc said:
It seems to me that almost all apartments allow pets.
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A prohibition against large breeds is pretty common among listings here in the city, which is kind of amazing to me because it's the small dogs that never seem to STFU.
 
DoctwoB said:
Honest question. Do you believe that most psychiatric illness in general is a manifestation of our society being poorly suited to fit our needs as human beings? Or is it inherent to our biology? I just find it hard to believe that we could evolve to have such high rates of depression and crippling anxiety.
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Mostly the former.
 
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shahseh22 said:
Regarding this topic, if the patient is requesting a Dog Breed such as (Rottweiler, Pitbull or German Shepard), can I refuse to write the letter? I don't feel comfortable with the liability it would pose if the dog were to bite a child, for instance, on a plane?
Click to expand...

Unless you're a veterinarian, I don't see how you could be held "liable" for the behavior of a dog.
 
splik said:
I love my emotional support cat. I would not be able to cope without him.
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That orange beast is magnificent. I'd be happy to write that ESA letter if you want to take him on vacation.
 
NickNaylor said:
In the big scheme of things I have just given up on fighting over ESAs. I just ask our clinic SW to draft the letter and I sign it.

I think most of the requests are complete nonsense and simply attempts to get their critter to fly on a trip or get into an apartment for free, but I have bigger fish to fry and don’t want to ruin the therapeutic alliance over something so trite.

But a piece of me dies with every one of these letters I sign.
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I get your point and while I agree it can result in the "pissed off" patients everyone here seems so avoidant to provoke I believe in most cases appropriately addressing areas in need of consideration or adaptation does patients a favor in the long tern with regard to growth. If me saying no to a ridiculous non-therapeutic accessory or inappropriate medication ruins the therapeutic alliance for my 15 minute med management patients I'm generally willing to take that hit.
 
Jules A said:
I get your point and while I agree it can result in the "pissed off" patients everyone here seems so avoidant to provoke I believe in most cases appropriately addressing areas in need of consideration or adaptation does patients a favor in the long tern with regard to growth. If me saying no to a ridiculous non-therapeutic accessory or inappropriate medication ruins the therapeutic alliance for my 15 minute med management patients I'm generally willing to take that hit.
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Don’t disagree with you, but there are other things for most of these patients that I consider to be more important than this issue which requires preservation of the therapeutic alliance. If these patients were simply q3mo depression in remission cases coming in for an SSRI refill, I’d have no problem talking about it and refusing to provide these asinine letters. Unfortunately that isn’t the case, and I’d rather focus on the more clinically relevant issues than make this the hill I die on.
 
I was recently talking to an attending psychiatrist with her own private practice. She used to get flooded with all of these letter requests for service animals, disability paperwork etc. After she started charging a flat fee (around $40-50) for writing any letters, the number of requests went down significantly and made things a whole lot more manageable. She was telling me to consider this in future, as my time is valuable too. Although she does accept insurance for office visits, insurance clearly won't cover letters... so patients have to pay this out of pocket, and she hopes this will only get patients to pursue these letters who really need it. Some patients do get pissed off knowing there is a charge, but they are welcome to go to their PCP or someone else for a letter if they don't like it.
 
rkaz said:
After she started charging a flat fee (around $40-50) for writing any letters, the number of requests went down significantly and made things a whole lot more manageable.
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I agree with the idea of charging for letters, but this amount sounds like a lot to me.
 
I would highly recommend that everyone here inform themselves as to the differences between the laws and requirements governing flights vs. housing vs. public areas. You are risking liability. There is a difference in how these letters are drafted.

Frankly, many of you clearly don't know the differences.
 
PSYDR said:
I would highly recommend that everyone here inform themselves as to the differences between the laws and requirements governing flights vs. housing vs. public areas. You are risking liability. There is a difference in how these letters are drafted.

Frankly, many of you clearly don't know the differences.
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And what liability would that be?
 
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