ESA for a surprising condition

[lockian]

I was covering for a colleague the other day and someone asked me for a ESA note. The condition for which the patient said they needed an ESA?

ADHD.

(I did not give the letter.)

Now the question is… is that a thing anyone has heard of, ESAs for ADHD? Is there any kind of argument to be made here about it being a helpful thing? I kind of feel like an animal is yet another thing to keep track of, which would make ADHD even harder to manage.

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[Old&InTheWay]

Not sure about an ESA, but I think some patients with ADHD could benefit from a trained service dog that brings them their stimulants and bites whenever they get off task.

 

[littlefred]

I mean, where's the evidence for ESA's at all?

 

[Taddy Mason]

I’ve had one patient request documentation for an ESA for ADHD but I have a firm stance that I won’t provide ESA letters/documentation for anyone regardless of diagnosis and just stood my ground. Same patient also requested that I complete long term disability paperwork for ADHD and was much more insistent over that than the ESA.

 

[deleted1100659]

I was covering for a colleague the other day and someone asked me for a ESA note. The condition for which the patient said they needed an ESA?

ADHD.

(I did not give the letter.)

Now the question is… is that a thing anyone has heard of, ESAs for ADHD? Is there any kind of argument to be made here about it being a helpful thing? I kind of feel like an animal is yet another thing to keep track of, which would make ADHD even harder to manage.

I have drafted a letter for you to use that I would write. here goes:

"To whom this may concern,

In regards to patient xxxxx, a service animal could be highly beneficial to him/her. However, it could be highly beneficial to literally everyone on the planet, as who doesn't love petting a cute dog when they're having a bad day? Does patient xxxx require a service dog for therapeutic effect? Until there is an objective measure, we may never know for certain. We can however, absolutely conclude that a cute dog can cheer almost anyone up, so everyone, including patient xxx, may benefit from a service dog. How does it benefit their ADHD? Your guess is as good as mine"

 

[Stagg737]

Not sure about an ESA, but I think some patients with ADHD could benefit from a trained service dog that brings them their stimulants and bites whenever they get off task.

Seems like a better use of an ESA than most anxiety patients want...

 

[Merovinge]

I was covering for a colleague the other day and ...

Oh man do we need a book or newsletter with stories of what is asked for when covering for a colleague. It's so painfully obvious when patients are trying to take advantage of coverage in medicine and certainly not unique to psychiatry.

 

[futureapppsy2]

Seems like a better use of an ESA than most anxiety patients want…

(Just a note here that ESAs aren’t service dogs. Service dogs need to be trained to perform specific tasks related to the handler’s disability and have much more extensive legal protections, such as being able to go in stores, restaurants, etc).

Honestly, I’m really dubious about the value of service dogs for mental illnesses. They make sense in the context of guide dogs, hearing alert dogs, blood sugar/seizure/gluten alert dogs, and helpers for people with physical disabilities, but it seems that a lot of people who want service dogs for psychiatric illness essentially want an ESA they can take into stores or a dog that can do stuff that will actually make their mental illness worse (safety behaviors/checking, for example). I can kind of see the “calming pressure” argument during panic attacks, but I’ve also seen people want this from 10-pound tiny dogs, so eh.

 

[birchswing]

I think this will be over soon like daylight saving and standard time finally is. I think it kind of is over really.

It is just culturally normal, in the US at least, to have small dogs with you as a close family member.

You can buy an ESA dog tag for a couple of dollars on Amazon.

If a letter from a psychiatrist is meaningless (I kind of agree on that), then is that any greater harm?

I think it's the same way people click Accept on Terms and Services without reading it or sign HIPAA forms without reading them.

In my experience, a small, cute dog can go anywhere.

Take a step back: at least two major outbreaks (avian flu and SARS) and one of the world's deadliest pandemics of all time (SARS-COV-2) are all linked to wet markets in China, and journalists in the West are writing about the plight of getting young people in China to embrace them again as they're a Chinese cultural institution that young people were apparently eschewing due to busy lifestyles and wanting convenience food. They closed for mere weeks. So doctors hand-wringing about the ethics of a 10 pound dog in an apartment, whether you write the letter or not (I'm not even sure why they would mind being denied—I am sure without even searching there is an online doctor that writes these letters without ever seeing you), seems superfluous. China wants exotic wildlife in dirty, enclosed spaces; they're going to keep doing it. Americans wants dogs in apartments; they'll do it. One seems different than the other, but still—where there's a will, there's a way, and one seems more important to stop than the other. But neither will stop. Covid literally didn't stop them. There was a ban on wildlife, but there are loopholes. And I don't have eyes on the ground, but I imagine it's back to usual in rural China.

OK, I just googled it. There are a gazillion sites where doctors do this for a set price online and promise a letter within 24-48 hours. It's not an issue. It's not a change because it's always been perfunctory. I guess the question is whether you feel comfortable directing your patients to these sites. I didn't even know they existed before they started typing this post; i just assumed they had to exist because why wouldn't they when everything has gone that direction. Hopefully the patients can figure it out if you don't want to tell them because the difference between someone having an ESA allowed or not is essentially analogous to someone knowing how to file their taxes to their advantage or not.

Edit: I had some caffeine and realized this probably sounded a little jagged.

To put a softer edge on it, I just think of the words themselves: emotional support animals. No one would have a pet if it weren't an emotionally bonding experience. Pets are ESAs for everyone. They don't provide eggs, milk, etc. I'm sorry you all are put in the bizarre position of approving something that already seems like an accepted social contract, but I also hate to see the most disadvantaged deprived of that contract that others can take for granted (meaning people with private houses live with their dogs, travel with them, etc.).

 

[lockian]

I think this will be over soon like daylight saving and standard time finally is. I think it kind of is over really.

It is just culturally normal, in the US at least, to have small dogs with you as a close family member.

You can buy an ESA dog tag for a couple of dollars on Amazon.

If a letter from a psychiatrist is meaningless (I kind of agree on that), then is that any greater harm?

I think it's the same way people click Accept on Terms and Services without reading it or sign HIPAA forms without reading them.

In my experience, a small, cute dog can go anywhere.

Take a step back: at least two major outbreaks (avian flu and SARS) and one of the world's deadliest pandemics of all time (SARS-COV-2) are all linked to wet markets in China, and journalists in the West are writing about the plight of getting young people in China to embrace them again as they're a Chinese cultural institution that young people were apparently eschewing due to busy lifestyles and wanting convenience food. They closed for mere weeks. So doctors hand-wringing about the ethics of a 10 pound dog in an apartment, whether you write the letter or not (I'm not even sure why they would mind being denied—I am sure without even searching there is an online doctor that writes these letters without ever seeing you), seems superfluous. China wants exotic wildlife in dirty, enclosed spaces; they're going to keep doing it. Americans wants dogs in apartments; they'll do it. One seems different than the other, but still—where there's a will, there's a way, and one seems more important to stop than the other. But neither will stop. Covid literally didn't stop them. There was a ban on wildlife, but there are loopholes. And I don't have eyes on the ground, but I imagine it's back to usual in rural China.

OK, I just googled it. There are a gazillion sites where doctors do this for a set price online and promise a letter within 24-48 hours. It's not an issue. It's not a change because it's always been perfunctory. I guess the question is whether you feel comfortable directing your patients to these sites. I didn't even know they existed before they started typing this post; i just assumed they had to exist because why wouldn't they when everything has gone that direction. Hopefully the patients can figure it out if you don't want to tell them because the difference between someone having an ESA allowed or not is essentially analogous to someone knowing how to file their taxes to their advantage or not.

Edit: I had some caffeine and realized this probably sounded a little jagged.

To put a softer edge on it, I just think of the words themselves: emotional support animals. No one would have a pet if it weren't an emotionally bonding experience. Pets are ESAs for everyone. They don't provide eggs, milk, etc. I'm sorry you all are put in the bizarre position of approving something that already seems like an accepted social contract, but I also hate to see the most disadvantaged deprived of that contract that others can take for granted (meaning people with private houses live with their dogs, travel with them, etc.).

Yeah, I didn’t give a letter this time and my out was that I don’t know the patient. But really, while I agree that there is not strong evidence for ESA’s, the arguments about the liability in providing a letter for having an ESA in housing, in my opinion, are overblown. I would not provide a letter for someone to have an animal in public places, because there the liability is higher, I.e. who knows if the dog will attack someone for example.