Are Emotional Support Animals Just Pets?
Would you like to cite research to me related to the benefits of “pets” to convince us they aren’t? Here is your chance to make public comments. 😉
The U.S. Department of Transportation (Department or DOT) is seeking comment in this Notice of Proposed Rulemaking (NPRM) on proposed amendments to the Department’s Air Carrier Access Act (ACAA) regulation on the transportation of service animals by air. The proposed amendments are intended to ensure that our air transportation system is safe for the traveling public and accessible to individuals with disabilities. Specifically, the Department proposes to define a service animal, under its ACAA regulations in 14 CFR Part 382, as a dog that is individually trained to do work or perform tasks for the benefit of a qualified individual with a disability, including a physical, sensory, psychiatric, intellectual, or other mental disability.0F 1 Furthermore, this NPRM proposes to allow airlines to recognize emotional support animals as pets rather than service animals. The NPRM also proposes to allow airlines to require all passengers with a disability traveling with a service animal to complete and submit to the airline forms developed by DOT attesting to the animal’s training and good behavior, certifying the animal’s good health, and attesting that the animal has the ability either not to relieve itself on a long flight or to relieve itself in a sanitary manner. In addition, this NPRM would clarify existing prohibitions on airlines’ imposing breed restrictions on service animals and would allow airlines to set policies to limit the number of service animals that one passenger can bring onboard an aircraft. This NPRM would also generally require service to be harnessed, leashed, or otherwise tethered. This NPRM also proposes requirements that would address the safe transport of large service animals in the aircraft cabin and would clarify when the user of a service animal may be charged for damage caused by the service animal. Finally, this NPRM addresses the responsibilities of code-share partners, among other provisions.
You can read more here (PDF) and also see the site and make and read comments here on Regulations.gov.
What are the ethics involved in psychologists (etc.) writing Emotional Support Animal “letters” anyway?
It is fun that this came up because I recently had a discussion on an email discussion list about this; specifically related to what therapists’ (specifically psychologists’) role(s) were ethically. I’m going to basically copy and paste an email for you below with minor edits. For background first you may want to check out this past article: Examining Emotional Support Animals and Role Conflicts in Professional Psychology; the basic gist is the authors pretty much argue that it is a forensic role that treatment providers should avoid. Jeffrey Younggren and others were the authors.
I don’t disagree that treatment providers may be taking on forensic roles when it comes to ESA’s (I don’t think Jeffrey Younggren would either). When it comes to these types of considerations though we can’t always speak in absolutes and treatment providers may possibly even ethically have some forensic functions. I also wonder if a forensic provider might even potentially be taking on a treatment function unwittingly when it comes to ESA’s (though this can be debated of course).
I do recommend the webinar to people though and truthfully I don’t disagree with all the cautions that Dr. Younggren throws out there. However, I think part of my ease in agreeing with him may be that he seems to not be a fan of ESA’s in general. I will throw it out there that I tend to be rather skeptical (and possibly too skeptical at times for a field like psychology) so recognizing that bias in myself I try to challenge my own assumptions. I am not sure how much of my thinking about making sure there is a proper assessment and concerns about fraudulent ESA’s is simply cover for the fact that I’m skeptical about ESA’s in general. On another personal note reflecting my bias, while I’ve suggested exercise and proper nutrition, I’ve never told a person that didn’t have a cat that they should get a cat. Also, if anyone wants my two cats I am willing to drive them to you and drop them off right now (just kidding). I also wouldn’t typically suggest dolphin or equine-assisted therapy but I recognize the literature on pets and that we live in a world where animals go in to hospitals and the Columbus OH Police have a “Therapy Dog” unit. My experience with the first call I ever received related to ESA’s might also impact my perspective: a local college student wanted a letter to have her pet in the dorm with her but had never pursued any mental health treatment (including no medication) and had no desire to pursue psychotherapy or medication. While I think someone could make an argument about having an ESA used in conjunction with an evidence-based treatment plan and could potentially have the ESA letter as leverage in treatment, etc.; I don’t think I could ever justify saying an ESA alone is an appropriate and adequate intervention alone and by itself for depression, anxiety, etc. If I took the role of exclusively a forensic practitioner and I was only writing a letter/report for an ESA yet I was aware that they had no intention of pursuing any (other?) intervention for their stated condition I don’t know that I would be excited about “prescribing” an ESA as the only intervention they were receiving.
Anyway, to get off the tangents- I think with that said my main concern is that the ethics-related discussion we’ve had about ESA’s seems to have become very absolute and either-or between a forensic vs treatment role. I think it is one of those situations where it may not be as clear-cut. For example, perhaps a treatment provider should never write these letters because it is a forensic opinion to a potential administrative body like an airline, landlord, college, etc. but I’m not really sold on that. Also, conversely, if a psychologist only approached it from a forensic perspective they may be missing things and opening themselves up to the notion that their examinee was actually not an examinee but potentially a patient they were prescribing an intervention for that they have added responsibilities for monitoring and offering additional evidence-based interventions for (or at least a thorough discussion of treatment alternatives). I think of other situations like what would the world be like if my pediatrician refused to sign my daughter’s sports physical form or if she had to go to a special forensic pediatrician to be written off from gym class after a stress fracture? That would be a bit annoying and excessive, though the roles do start to blur. I don’t argue that things need to be done by forensic “specialists,” just people who are competent. However, what I do agree with is when applicable and possible the same professional shouldn’t be engaging in multiple roles that they may be equally competent for- particularly between forensic and treatment roles. I talked about role conflicts related to disability cases in a blog post I wrote back in 2016: http://psychology.news/news/2016/05/12/ethics-post-psychologists-does-it-matter-who-butters-your-bread/
I agree with much of what has been said in relation to forensic roles in the discussion on the list serv so far. However, we shouldn’t go to absurd extremes. While I think disability exams should be done by neutral, independent third parties, I would never go so extreme as to say that a psychologist providing treatment (and not a forensic disability evaluation) should absolutely never sign something like an FMLA form for their patient to be off work. I wouldn’t say that despite the fact that we start to dance into that gray area where things are no longer easy. Ethical decision making isn’t always black and white and either or as we all know. I think ESA’s are probably a good example of one of those instances so risk management is one reason why you don’t see many psychologists advertising the service and looking to jump in to writing ESA letters- especially since it could associate you with shady websites that advertise things like “95% of our applicants get approved.” I offer no opinion on whether people should be prescribed ESA’s in general (I tried to be clear on my bias on that), but I do think it may be one of those situations where the boundaries between forensic practice and treatment are more blurry and can’t practically be as well-defined as we’d like in a perfect world. For some further vague and blurry cautionary language APAIT also has a Risk Management page on their website that also mentions ESA’s (and animals in your office): https://www.trustinsurance.com/About/TrustPARMA/Risk-ManagementFAQ/Risk-Management-Animals-and-Therapy
Much like some other things in practice, I don’t necessarily think ESA’s can be seen as something exclusively done as a forensic evaluation and that a treatment provider shouldn’t ever do. However, I would throw a heap of caution not just on the treatment provider writing a letter but also a forensic practitioner thinking about it from a forensic perspective since there could also be functions we associate with treatment that should necessarily be involved in something like an ESA. Forensic practitioners are not necessarily free of the requirements we typically associate with treatment providers in these instances.
Anyway, I hope you enjoyed yet another rant from me so soon; thanks for reading,
P.S. If you want to get an email the next time I write a blog post you can make that happen here.