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Who Can Prescribe an Emotional Support Animal?

Pecan is a fluffy bunny with floppy ears and a kind spirit. Although he weighs just one pound, for Caitlyn, Pecan is a lifeline. As an emotional support animal, he’s helped her overcome debilitating depression and stay on track with her studies at the University of Tennessee in Knoxville. 

“Leaving for college made me realize how much I need companionship,” says Caitlyn (we’re withholding her last name for privacy). “It didn’t matter what shape or form it came in.” 

Pecan, the bunny.

Caitlyn is one of many Americans with a pet that’s also certified as an emotional support animal. The government doesn’t keep a registry of ESAs, but estimates as of 2015 were in the tens of thousands, and those numbers have risen sharply since. 

ESAs differ from service animals, typically dogs, which are trained to perform specific tasks, such as anticipating their owner’s seizures in real time. Service dogs are federally registered and protected by the Americans with Disabilities Act, so they are allowed into any public place. 

As their title indicates, emotional support animals are simply there for emotional support. While they’re not given special protections in public spaces, having an ESA allows people to bypass housing regulations so they can live with their pet no matter what. 

Any licensed mental health professional, which can range from physicians to clinical psychologists or social workers, can “prescribe” an ESA to help treat or regulate a patient’s physical or mental health. These companion animals can bolster those who live with clinical depression, post-traumatic stress disorder and a number of other conditions. Research supports these claims; just interacting with an animal can flood your body with uplifting hormones like oxytocin. 


What Parents Should Look For in a Doctor

If a patient’s existing pet acts as a built-in support system, a provider can certify it as an ESA to ensure the patient can live with their pet at home.

Controversially, a not-insignificant number of people take advantage of the ESA approval process to avoid landlords’ pet fees and other rules. This has caused some confusion over the definition of an ESA and who is eligible to have one. To help clear things up, here’s some guidance on emotional support animals. 

More than just a furry friend

The concept of an ESA has actually been around for decades. 

When the federal government enacted the Fair Housing Act of 1968, it blocked landlords from discriminating against people with disabilities, giving tenants the right to “reasonable accommodation” to help them manage their disability. The right to an emotional support animal — an animal that isn’t trained for tasks but helps a person regulate their health or mental health issues — was established in 1973 and reaffirmed in major legislation multiple times since. 

Under this provision, a person can claim an ESA if they live with a physical or mental impairment that substantially limits one or more activities. Major depressive disorder, bipolar disorder, PTSD, schizophrenia, obsessive-compulsive disorder and other conditions meet the criteria. A physical impairment or a developmental disability that substantially limits one or more activities can also qualify.

At its most basic, an ESA designation means your landlord can’t charge a pet fee or enforce a breed restriction. They can’t prevent you from moving in with your animal, even if the property has a ban on pets, nor can they evict you for getting a pet. (There are a few caveats: Your pet has to be well-behaved, so it’s not destroying property or disturbing other residents.)  

In the past, ESAs were allowed on airplanes, but in 2020, the U.S. Department of Transportation changed its guidelines after a sharp rise in animal-related incidents during flights made it clear that people were simply purchasing ESA designations through online services in order to fly with their pets.

Puppy (or gator) love

Most ESAs are typical house pets, like dogs, cats, rabbits and fish, but some people find emotional support in less conventional pets, like ducks, reptiles and squirrels. A robust body of research has shown that bonding with animals can help people with debilitating mental health conditions live easier, more fulfilling lives. Simply interacting with an animal, even if it’s an alligator, can have therapeutic effects. 

“We know that petting and having physical contact with animals can create an oxytocin release in our body, which in turn lowers our heart rate and blood pressure,” says Janet Hoy-Gerlach, a professor of social work at the University of Toledo in Ohio.  

These encounters may help alleviate symptoms of panic disorders, anxiety attacks and PTSD, and can also help anyone struggling with loneliness or social isolation, says licensed veterinary social worker Aviva Vincent of the University of Tennessee, Knoxville. 

Research shows that for many individuals struggling with depression, the routine and responsibility of pet ownership helps address symptoms simply by providing a reason to get up or leave the house. Hoy-Gerlach and Vincent collaborated on a recent study which found that ESAs encouraged their owners to engage more with the outside world. 

“They feel obligated to get out of bed and feed the animal, but that in turn actually helps them feel better than lying in bed,” says Hoy-Gerlach. “And once they’re up, they might then have a meal or take their medicine.” 

Pecan, for instance, has helped Caitlyn fight depressive episodes. “Even when I cannot care for myself, I will still get out of my bed for Pecan, which is better than not getting out of bed at all,” she says. “I even keep my meds near his food to remind myself to take them.” 

While emotional support animals can provide a ton of support, they’re not miracle workers. Vincent, program director at a therapeutic horse farm, reminds people that while horses can provide profound benefits to humans, “They’re still a big thousand-pound animal that has the capacity to act as a thousand-pound animal.” 

“Sometimes that’s really hard for us, because we expect them to carry the weight of our world on their shoulders,” Vincent says.

The road to an ESA

If you think an ESA is right for you, talk to your therapist.

Any licensed mental health provider can prescribe an ESA or provide certification to a patient’s existing pet. This provider has to understand the patient’s diagnosis and treatment. They must also determine that the pet reduces some impairment caused by the patient’s condition. 

Once a provider agrees that a patient could benefit from an emotional support animal, they write a verification letter. This document attests that the patient has a qualifying condition and that the animal is necessary to reduce impairment or distress related to that condition. The patient can then supply that letter to a landlord (or a school, for those living in student housing) as proof of the need for an ESA and that they are entitled to any benefits that brings. Privacy law prohibits the landlord from asking for specifics about the person’s diagnosis or condition. 

Unlike ADA-certified service animals, your pet does not need any kind of vest or certificate to demonstrate its designation. In fact, it’s best to avoid online websites that sell such vests or certificates: Hoy-Gerlach explains that these sites are charging money for a service that should be provided by your doctor, who knows you and treats you. 

Many online providers who offer these quick certifications are licensed and typically do a quick consultation by phone or email, but Hoy-Gerlach calls the practice “ethically questionable.”

“If people meet the criteria, that should be something they can get from their mental health provider,” she says. “That shouldn’t be something they’re paying hundreds of dollars for, for a five-minute conversation.” 

Hoy-Gerlach trains mental health providers across the country in ESA verification to ensure that therapists know how to help qualified clients get the support they need. 

After Caitlyn’s therapist wrote her ESA letter, Pecan was approved to stay with her in her dorm. For her, he’s worth any hoops she had to jump through. “He is a very sweet, curious little guy,” she says. “When I am in a difficult place, at least Pecan is there with me.”

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