There is a common misconception that service animals and emotional support animals (ESA) are one and the same but this is not true. An emotional support animal provides emotional support simply by being there, whereas a service dog is trained for a specific task for a person with a disability. Having an ESA may help with emotional regulation, grounding, and even give someone a sense of purpose, which all have a positive impact on mental health. There are many things to consider when asked to write a letter advocating for an ESA. I do not provide ESA letters at the first visit with a patient and would not consider providing a letter until a therapeutic relationship was established. I want to know my patient's current struggles, patterns of behaviors, ability to take care of themselves, impulsivity, what happens when they cannot regulate their emotions, and their current support system. If I had a patient with a history of impulsivity, who is in crisis, or is struggling to take care of themselves, then adding an animal to take care of, would likely not go well. Having an ESA is not easy and my patients need to know this as they are responsible for providing care, training, health check - ups, vaccinations, etc.
For many individuals struggling with anxiety, depression, or PTSD, an emotional support animal isn't just a pet, it's a partner in co-regulation. The presence of a calm, affectionate animal can reduce sympathetic nervous system activation, ease hypervigilance, and offer nonjudgmental companionship. During teletherapy sessions, I have had the privilege of witnessing clients shift from a state of acute nervous system dysregulation to calm, regulated breathing simply because their companion animal was present. I have also observed individuals struggling to attend to their own acts of daily living (ADLs) get back on track by first focusing their attention to the needs of their companion animals. If you are seeking an ESA letter and wondering what a legally valid ESA letter looks like, here are a couple of the parameters: 1. The letter must be written on the clinician's official letterhead 2. The letter must be issued by a licensed mental health professional (psychologist, counselor, psychiatrist, or social worker) 3. The letter must Include the clinician's license number and jurisdiction 4. The letter must state that the individual has a diagnosed mental health condition that substantially limits major life activities, and that the ESA is a necessary accommodation for their emotional or psychological wellbeing I often caution clients: that many online ESA services do not meet legal standards. Most websites produce generic letters without any clinical assessment. In order to avoid being scammed, it is best to speak directly to a mental health professional to request an ESA letter. Before seeking an ESA letter, it's important to know what power these letters do an do not have. For example, the Fair Housing Act (FHA) is the most robust protection—requiring landlords to provide reasonable accommodations for tenants with ESAs, even in "no pet" housing, unless it poses an undue burden or fundamental alteration to the property. On the other hand, the Air Carrier Access Act (ACAA) previously offered similar protections to the FHA, but as of 2021, emotional support animals are no longer guaranteed access on flights. Only trained service animals (e.g., for visual impairment or medical alerting) are now protected for air travel.