https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6563823/

The service animal, usually a dog, is an animal that is specially trained to perform tasks for an individual with a disability. The disability can be psychiatric in nature, but the animal must be tasked trained to assist with that disability.

Some of these tasks include attending to an individual’s mobility and activities of daily living.

Helping to remind an individual to take their medication.

Assisting an individual during and /o after a seizure.

Supporting an individual with autism.

Applying sensory commands such as lying on the person or resting their head on the individual’s lap to help the individual regain behavioral control.

Service dog verification works via an honor system, which can be problematic, especially in the case of a psychiatric service dog where the disability may not be visible. In addition, their is no requirement for professional training. Under the Americans with Disabilities Act (ADA) individuals with disabilities, including those of a psychiatric nature, can bring their service animals into places where dogs may not be allowed. This does NOT include private clubs, religious organizations, or places of worship that ARE NOT open to the public.

Emotional Support Animals, or ESAs, DO NOT qualify as service animals under the ADA and are considered pets. They are no longer allowed in aircraft carrier cabins after the US Department of Transportation revised this act in December of 2020. They ARE still covered under the FAIR HOUSING Act.

Research has shown that service animals are able to help owners gain a greater degree of independence and participate in everyday outings that may otherwise had been a struggle. Overall, service animals are known to improve owners’ quality of life. ESAs, on the other hand are not evidence-based treatment for psychiatric disorders nor are they specifically trained to help with one. Pets however are known to benefit patients with mental conditions through the development of a strong bond and the contribution they make to emotional support in times of crisis.

Mental health professionals documentation?

A mental health professional can write a letter for a patient at their request, stating they have an emotional disability they are being treated for and the letter should be given to the patient to use as he / she /they deems fit. Patients should be encouraged to have the animal pass a standard basic obedience test as given by the AKC. You as a mental health professional can not vouch for the behavior of the animal.

If the letter is for documentation for a service animal, it can include how the animal helps alleviate symptoms of the patient’s condition. I strongly recommend referral to professional trainers that have a background in the mental health field so a coordinated treatment plan can be devised. The trainer is also able to write a letter stating how the animal is trained to assist.

Writing a letter for a patient confirming a dog is needed to assist with a disability does not make that animal a service animal. There are no current standards for conducting evaluations to determine the need for a service animal or ESA. This letter is your recommendation. If written, you should be able to defend your recommendation in a court of law. It is a crime to fraudulently certify an animal as a service animal in some jurisdictions, and such conduct could result in disciplinary action by your licensing board. There are cases where having an animal may be harmful or may worsen a psychiatric condition.

In summary, I am a strong advocate for canines in helping psychiatric patients both as ESA’s and psychiatric service dogs. I do believe there are certain situations where a dog is necessary for the most optimal functioning of a patient, especially where response to medication is only partially effective. In advocating for patients, animals must be tasked trained and should be able to pass basic obedience testing. If a patient has not been able to demonstrate this training, then a letter should not be written. The patient also must be responsible, and can care for the needs of the animal. In the case of an assistance animal helping a patient with dementia, arrangements need to be made for the care of the animal as well.

At Puppies with a Purpose we love to see articles written about Animal Assisted Therapy and its positive effects on humans.

The following is an article from TIME Magazine written by Alexandra Sifferlin. Thank you for reading!

During a couples-therapy session, therapist Ellen Winston of Lakewood, Colo., brought along her assistant, Sasha — who happens to be a dog.

The couple were dealing with behavioral problems in their children and, on top of that, getting a divorce. “The split was not entirely amicable, and there were very hurt and angry feelings all around,” Winston says. “The parents struggled to have a civil conversation and it often escalated into yelling, and then tears, on both sides.”

During the sessions, the couple would sit on complete opposite sides of the couch. Sasha would hop in the middle, curl up and fall asleep. Both partners would stroke Sasha at particularly emotional moments, and it helped them calm down. Still, they continued to get agitated, often letting therapy sessions intensify into screaming matches. When that happened, Sasha would quickly get up and walk to the door. Winston used those moments as teaching points.

“We [discussed] that if this is how they interact regularly, their children were likely also picking up on their moods and acting out as a result. This was one of the first times they realized that their children may be impacted by the parents own relationship.”

Winston’s sessions are one of the ways animal-assisted therapy is changing. Animal-assisted therapy is different from service animals who accompany someone dealing with anxiety or depression. Those are certified as emotional-support animals (ESA), who are daily companions and covered under the Americans With Disabilities Act. Therapy animals, on the other hand, are meant to be used in counseling, whether a professional session or an informal one. Although the American Psychological Association and the American Psychiatric Association have no formal position on animal-assisted therapy, there’s evidence that small practices and individuals are exploring it. Animals are appearing in all sorts of places: in emergency rooms, prisons, juvenile-detention centers, nursing homes and, increasingly, your therapist’s office. There are no official numbers yet, but Pet Partners, a nonprofit that registers animals for animal-assisted therapy use (the largest organization to do so in the U.S.), says there were more than 1 million reported interactions between registered animals and patients last year. This number includes everything from nursing-home visits to therapy sessions.

Kathryn Kimbley, director of HumAnima CIC, an animal-assisted therapy service in West Midlands, England, brings her therapy dog Flossie to individual sessions with clients, as well as to larger groups, to comfort patients with depression, behavioral problems or even mental-health issues like PTSD. “Dogs can act very much like a social catalyst. In various settings they will encourage people to interact with one another,” Kimbley says. “It lifts the mood and makes people feel better.”

Kimbley has found that her clients feel more at ease talking to her when they’re physically distracted. “If someone is talking, they might sort of tap their foot or fidget. They have this energy they want to redirect somewhere, and they have no outlet for it. So if Flossie is in this situation, it is much easier for them.”

A therapy pet can also modulate a relationship between a client and his or her counselor. “You are dealing with powerful and overwhelming emotions, but you can’t hug a client,” says Kimbley. “With a dog present, that need is therefore met.”

Emerging research confirms the benefits of pets on people. A 2009 study found that preschool kids with special needs were better able to follow directions during assigned tasks if they were with a trained poodle than when they were alone, with another human or with a stuffed animal dog. Other research has shown that animals are social facilitators: people tend to be viewed as more trustworthy if they have a pet, and pets are known to instigate more conversations among strangers. Animals can also lower a person’s anxiety level. “You can see some of the same changes in physiological response from looking at a fish tank as you do with petting a dog, cat or a horse,” says Sheryl Pipe, an adjunct professor of anthrozoology (the study of human-animal interaction) at Canisius College in Buffalo, N.Y. “But in terms of social facilitation, that is better suited for mammals.”

Of course, there are certain people who don’t respond well to animals in their sessions, and therapists need to distinguish between those who will benefit and those who need pet-free space. And not just any animal will work. Therapy animals are most successful when they’re a bit older and have more experience. There are no set guidelines for training animals used in therapy, and many groups use their own rubrics. Kimbley makes sure her animals are properly socialized and can react normally in a variety of situations.

But, Pipe warns, a therapy animal should be considered a partner rather than a tool. “We tend to have a greater willingness to consider the impact on our partner than our tools. We have to make sure an animal is happy participating and still has adequate time to behave like the animal that they are,” says Pipe.

“The field is still relatively in its infancy, but the data that’s beginning to come in is really encouraging in terms of how impactful this work can be.” Man’s best friend, it seems, can also be man’s best medicine

Campuses Debate Rising Demands for ‘Comfort Animals’

By JAN HOFFMANOCT. 4, 2015
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Mary McCarthy and Carl, her rabbit, with her roommate, Rachel Brill, and her dog Theo, in their campus apartment at St. Mary’s College of Maryland. Carl and Theo are emotional support animals, permitted by the college to live on campus. Credit Drew Angerer for The New York Times

ST. MARY’S CITY, Md. — Rachel Brill and Mary McCarthy are seniors and longtime roommates at St. Mary’s College of Maryland. This year, they share their four-bedroom campus apartment with two other female students. Also, Theo and Carl.

Theo, easygoing and unflappable, is a tawny, 103-pound, longhaired German shepherd. Carl, an energetic charm magnet, is a jet-black, 1.5-pound Netherland Dwarf rabbit.

House rules: Carl must reside in a pen under Ms. McCarthy’s raised bed; Theo snoozes in a crate in Ms. Brill’s bedroom. Carl cannot be let loose in the living room, where Theo likes to hang out. “We’re still very careful because we don’t want there to be an issue with Theo and Carl,” Ms. McCarthy said. “We’re both very anxious people.”

And that is exactly why Theo and Carl have permission to live in campus housing.

Like many schools across the country, St. Mary’s, a small, public liberal arts college, is figuring out how to field increasing requests for animals by students with diagnosed mental health problems. Last fall it began allowing “comfort animals” for students like Ms. Brill, Theo’s owner, who has anxiety and depression, and Ms. McCarthy, Carl’s owner, who gets panic attacks.
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“When I feel a panic attack coming on,” Ms. McCarthy said, “feeling his heartbeat helps me regulate my own.” Credit Drew Angerer for The New York Times

Anxiety, followed closely by depression, has become a growing diagnosis among college students in the last few years. The calming effect of some domesticated animals has become so widely accepted that many schools bring in trained therapy dogs to play with stressed students during exam periods.

But as students with psychiatric diagnoses are asking to reside on campus with their own animals, schools with no-pet housing policies are scrambling to address a surfeit of new problems. How can administrators discern a troubled adolescent’s legitimate request from that of a homesick student who would really, really like a kitten? If a student with a psychological disability has the right to live with an animal, how should schools protect other students whose allergies or phobias may be triggered by that animal?

The topic is being hotly debated by college housing and disability officials in the wake of discrimination lawsuits filed by students who were denied so-called emotional support animals. Last month, on the eve of a trial in a case closely watched by administrators, the University of Nebraska at Kearney settled with the Justice Department, agreeing to pay $140,000 to two students who had been denied support animals, and spelling out protocols for future requests. Recently, a federal judge refused to dismiss a similar case against Kent State University.

“The disabilities services people are all looking at what they need to do to make this work,” said Jane Jarrow, an educational disabilities consultant who is teaching “Who Let the Dogs In?” — an online course about emotional support animals — for the fourth time this year. “We’re way past pretending it’s not going to happen.”

In the years before support animal lawsuits, universities found it relatively easy to say no to requests for animals. But now, said Michael R. Masinter, an expert on disability law at Nova Southeastern University in Florida, “schools think it’s easier to say yes than no because property damage is cheaper than litigation.”

Perhaps that explains the 95-pound pig that a freshman was allowed to bring to her second-floor room at Washington State University. Unfortunately, when led to the stairs, the pig balked. The freight elevator made him anxious, too. So he stayed in the dorm room and used a litter box.

“The other students thought the pig was kind of cool, but less cool when it began to smell,” recalled Hannah Mitchell, the dorm’s residential director at the time. “We talked about bathing it. But dorm bathrooms aren’t built for washing animals.”
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A washing machine designated for students with animals protects students with animal allergies. Credit Drew Angerer for The New York Times

Pig and student transferred to a dorm with ramps. Eventually, both moved off campus. Custodians said the dorm room’s carpeting had been chewed-up, the furniture gnawed and closet doors knocked off.

The overwhelming majority of support animal requests are for dogs and cats. But schools have had requests for lizards, tarantulas, potbellied pigs, ferrets, rats, guinea pigs and sugar gliders — nocturnal, flying, six-ounce Australian marsupials.

Clearly, many requested animals are students’ pets. But what is the difference between an emotional support animal and a pet that also provides support?

The distinction depends less on the animal and more on the student: whether the student has a diagnosed psychiatric disorder, and can document that the animal is therapeutically necessary.

“Do we have people trying to get their pet across as an assistance animal? Sure,” said Jamie Axelrod, director of disability resources at Northern Arizona University, where requests for support animals rose to about 75 last year from a handful a few years ago. “Do we have people who legitimately require one? We do.”

“You have to rely on a treatment provider’s ethical sense that they’re doing what’s right for their patient,” Mr. Axelrod added. “But it’s a new gray area.”

Research on the therapeutic value of animals is limited. Some studies have shown that they can provide a short-term benefit, particularly in reducing anxiety and depression. A long-term therapeutic benefit, however, has not been definitively established by randomized control trials.

Joanne Goldwater, associate dean of students and director of residence life at St. Mary’s College of Maryland, is not concerned about objective evidence. “Having that animal has clearly helped to reduce stress and anxiety for some students,” she said, “which helps them progress towards their degree.”

Students concur. Ms. Brill, a film major, wrapped her arms around Theo’s neck. “Theo helps me when I’m feeling isolated and depressed,” she said. On wobbly days, he gives her structure, she added, because she must get out of bed to feed, brush and walk him. “All I have to do is look at Theo, squish his face a lot in the evenings, and he’s like, ‘Hey, I love you!’ ”

Her roommate Ms. McCarthy, a psychology major, tucked Carl into her neck, stroking his silky fur as he eagerly nuzzled her ear. “When I feel a panic attack coming on, feeling his heartbeat helps me regulate my own,” she said.

And animals have inspired creative compromises. At St. Mary’s, animal owners must do their laundry in designated washing machines and dryers to avoid cross-contamination with the clothing of students with animal allergies.

At Western Washington University, a student asked to keep her six-foot snake. But the school prohibits “live feeds,” said Karen M. Walker, the associate housing director. The solution? Frozen mice, served thawed — a solution amenable, so far, to the school, student, suite mates and snake.

Whether schools must permit support animals depends, generally, on federal housing law. The Nebraska suit was filed by the Justice Department in 2011 on behalf of Brittany Hamilton, whose four-pound miniature pinscher, Butch, would put his paws on her shoulders to quell her anxiety attacks. She wanted Butch to live in her university apartment. The university said no.

But in 2013, a federal judge ruled that the university’s residences were bound by the Fair Housing Act, which protects individuals with disabilities from discrimination. Among the act’s “reasonable accommodations” for residents with psychological disabilities are animals that provide emotional support.

While the consent order in the Nebraska case last month is not binding on other colleges, it lays out some guidelines. The university can deny a request if the animal is too big for the quarters or aggressive, or damages property.

And if a student’s documentation looks insufficient, a school can contact the student’s medical provider — a pushback against emotional support animal letters downloaded on the Internet or churned out by cybertherapists who, for fees of up to $150, will Skype with the student and then issue the document. Universities have been circulating a watch list of such practitioners.

Some institutions are managing the issue with a matter-of-fact attitude. “We use our code of conduct for animals as well as people,” said L. Scott Lissner, the Americans With Disabilities Act coordinator at Ohio State University. “We don’t let our students walk across campus and lick people unless it’s welcome, so we don’t let the dogs do it. We don’t let students howl all night.” And, he added, “they can’t go to the bathroom wherever they want.”

“Myles” of Service

     Until recently, my repertoire of life-skills gave me the ability to successfully manage my intermittent anxiety so that I could function normally in life. Like most people, I worked hard, enjoyed great times with friends and family, traveled, managed my finances, enjoyed hobbies, and was always looking for new ways to enrich my life. Anxiety was something that I had never actually identified with or considered to be an issue that required my attention. That is until my mind and body were bombarded with extreme symptoms of dreadful thinking, dizziness and unexplained panic that ultimately consumed me. My life as I knew it essentially stopped. I existed in a perpetual loop of stress hormones racing through my body causing unexplained bodily symptoms and, of course, generating more fear. Like most adverse things that I have faced in my life, I made a decision to approach this new condition in a logical, well-tested manner. Most evidence-based research at the time showed that psychotherapy, coupled with anti-depressant medicines (SSRIs), were the most effective treatment of anxiety, so I embarked on a newly found mission of putting this anxiety stuff behind me.

     I was familiar with the benefits of talk therapy, and had also seen the effectiveness of medicine in treating people with both depression and anxiety. These two approaches seemed acceptable to me so I embarked on my own individual therapy and scheduled an appointment with a psychopharmacologist. The well-known SSRI, Celexa, was prescribed to me and I began my regimen, as advised, with a very small dosage that was to be increased with time. Surprisingly, the side effects that I experienced after taking my very first dosage so severely increased my panic symptoms that I made a frantic call to my doctor and climbed into bed to ride out the storm. This led to a series of bi-weekly appointments – each offering a different prescription of intolerable anti-anxiety medication intended to calm down my central nervous system. As each new pill failed to provide relief, my doctor finally informed me that she had no other medication to offer me. Her intuition was that I had linked my anxiety to medication and it was the anxiety that was interfering with the effectiveness.

     One can only imagine the disappointment and terror that I felt when my doctor calmly looked at me and very directly said, “I don’t have any more medication to try.” I remember thinking that this meant I would forever live with these uncomfortable, overwhelming feelings of fear and panic that were stealing my life from me. For some reason, I remembered that in one of my many appointments with my doctor, she had casually mentioned her involvement with the organization, Puppies With A Purpose, and discussed how dogs had been proven to be an effective tool in helping people who were suffering with anxiety, and other psychiatric disorders. At the time, I didn’t really embrace the idea because I was living in a “no pet” building and didn’t understand the laws and rights associated with psychiatric service dogs. Later, when I asked her about it, she explained that my specific disorder would qualify me for a service dog, and provided me with details regarding my rights to obtain a service dog, even in a “no pet” building. I left her office that day on my newly altered mission, complete with contact information for local professionals who could help me locate and train a dog to help me.

     My individual psychotherapy continued as I began the process of finding a dog to help me cope, and my anxiety symptoms remained a constant presence in my day-to-day life. After meeting with a woman who specialized in training psychiatric service dogs, I located and adopted a dog who I quickly named Myles because he had traveled many miles from the “Shaggy-Dog Rescue” in Texas to his new home in New York City. I will always remember that day when my friend drove me north, about a half an hour out of the city, to pick up Myles, who was being delivered by way of semi-trailer truck along with many other rescue dogs from the south. As he sat on my lap for the first time on our way back to the city, he looked intently and questioningly into my eyes for an extended period of time. I remember feeling somewhat cautious, as I was trying to read him and watch his reactions, knowing very little about his temperament. After a minute or so, he sighed heavily and rested his head against my chest as if to say, “I’ll stay.”      

     Anyone who has experienced an anxiety disorder understands how pervasive one’s focus becomes on the anxiety itself. It is a vicious cycle of fearful thoughts—hormonal reactions—bodily symptoms— more fearful thoughts. It is, in fact, the symptoms brought on by the overstimulation of the central nervous system that causes many people, including myself, to withdraw from the outside world and remain in the safety zone of one’s home. Needless to say, having a dog to walk quickly breaks this pattern of avoidance, and this was the first accomplishment of Myles in his role as my unofficial service dog. I can still remember how uncomfortable and unsteady I felt during those first few weeks of walking Myles, wondering how I was ever going to survive this new responsibility.

     It didn’t take long for me to appreciate the distraction that walking Myles provided. It was hard to remain focused on my own anxiety when my new companion was exhibiting anxious signs of his own in response to his relocation – a loud, fast-moving city. Myles chased unfamiliar objects like motorized wheelchairs, lunged at dogs that he deemed threatening, and became crazed by the frolicking squirrels in Central Park. I feared that there was no way that he was ever going to be trainable, yet also noticed that I was beginning to look at life a bit differently. Nearly every walk with Myles brought a bit of new insight related to my anxiety. The controlling, perfectionistic nature of many anxiety sufferers, like myself, began to shift as Myles had his good days and his bad days. I found myself easing up on my expectations of him and relaxing more with life, in general. Change was now more acceptable for some reason. Unknowingly, Myles also reminded me that staying with him in the present moments of our walks together was a simple antidote to my fears of the future, which had previously haunted me.

     As my outlook on life improved and my anxiety symptoms began to subside a bit, Myles was enrolled in a rigorous behavior-training program designed to ready him for certification as a psychiatric service dog. Three days a week, his trainer picked him up early in the morning and worked with him, teaching commands that were easily transferrable. I learned how to reinforce his good behavior, respond to his negative behavior, and after several months of hard work, Myles finally earned a vest that allowed him to be at my side whenever I needed – restaurants, cross-country flights, doctor’s appointments and even at work.

     The recovery from my anxiety disorder has been a lengthy, ongoing process that has caused me to greatly change how I view life. By identifying the underlying factors of my anxiety in therapy, I have also been able to make some important behavioral changes in the way I have been living. I am convinced, however, that it is what Myles entered into the recovery equation that has been the most valuable. Along with helping me to exhale and relax as I began to increase my interaction with the outside world, his presence gently forced me to shift my focus to something outside of myself. Myles was probably the most helpful when I would struggle to contain the irrational fears that would unexpectedly surface. From the very beginning, he seemed to have an intuitive way about him and would come close to me when I was the most vulnerable and really locked into my fear. “Thankful” wouldn’t come close to expressing the feelings of gratitude that I have for Myles, and for the opportunity to experience such a connection with a dog, my psychiatric service dog. I am also thankful for an organization like Puppies With A Purpose that works hard to educate people on the undeniable usefulness of dogs as support for those who are struggling with emotional and psychiatric disorders.

My sister Katie is an extremely outgoing, funny, caring person who will talk to anyone for hours. She loves going out to the mall, watching movies and spending time with family and friends. However my sister Katie is very different from most other 27 year olds, she has Autism. Living with Katie is a very rewarding, but also a very challenging experience. Her funny, innocent personality can be a joy to be around but Katie also suffers from severe behavioral outbursts that my family has deemed “meltdowns”.

Her meltdowns can sometimes come out of the blue with no warning or can be a process that progressively gets worse. During a meltdown she will get very anxious and frustrated at first, which will then escalates into severe anger. She will begin screaming and acting out much like a young child having a temper tantrum. However, hers can get violent where she will throw and break things and she often tries to run away during the process.

Katie likes order and control, and a lot of her meltdowns are prompted by things not going as planned or her not getting her way. When this happens and she is about to meltdown she can sometime be calmed by having her attention averted elsewhere. Nothing is as calming and as effective at avoiding a meltdown as an interaction with a dog.

Katie has always adored dogs and they have always been a very important part of her life. When Katie is upset, being able to pet and talk with a dog is very therapeutic to her. She will talk to them and cry to them as if they are real people and this provides a channel for her anxiety to escape without having it escalate to a full meltdown. There have been many times when she is upset and she is unable to see the dogs, so she will call someone to talk to their dogs over the phone to express her emotions. The dogs don’t have to do anything but sit there and get pet, but Katie’s entire day can be positively transformed by even the slightest interaction with a dog.

Even when she is not having behavioral problems Katie is constantly thinking about the next time she will be able to see a dog. She even gets presents and cards for all the dogs she knows every Christmas. Anytime she sees someone walking on the street with a dog she stops to pet it, which allows her to have a calming social interaction in crowded places. She even began going to an animal shelter a few times a month to help take care of dogs, and we have noticed that it has helped her baseline anxiety directly after going to the shelter.

I have seen the importance that dogs have played in my sister’s life, and how beneficial they have been to helping her achieve greater happiness. There is something extremely special about the interaction of a dog and human that allows people to instantly feel better. They are a nonjudgmental, soothing, unconditional source of support. I believe therapy dogs can help so many people with a multitude of different issues and it is my hope that many more people will begin to use them.

Have you or someone you know been positively impacted by therapy dogs? We would love to hear about your experience and how it has helped you. If you would like to share your story in order to help raise awareness of the importance of therapy animals please  email puppieswithapurposeinc@gmail.com!