Emotional support animals

[Mass Effect]

I don't see a benefit or empirical basis to allowing an anxious patient to never leave the house without their ESA, that is probably maladaptive.

However living alone with no other mammals I think is horridly unnatural for human beings, and we have evidence that it is bad for them. There is some evidence about the health benefits of pet ownership.

I don't agree there is no evidence a patient is not better served not coming home to an empty apartment, especially with certain mental illnesses.

It would probably be better for the patient to have a roommate or seek humans some way, and maybe one should think about if the pet prevents this. However that isn't always feasible and sometimes a substitute mammal is needed.

We go off label all the time and this is one example where I would because it makes sense.

That's cool. The next time I get one of these patients, I'll refer them to you. I refuse all of them.

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[Stagg737]

OK, well, it goes to court and they lose. Problem solved. But the point is it actually has to be a problem for it to be a problem, which sounds fair to me.

Just because it hasn't been taken to court doesn't mean it's not a problem. That logic is just silly.

 

[Mass Effect]

As for noise, that also applies to animals for disabilities.

Also the patient that needs sound, there are all kinds of options for wireless earbuds that can connect to just about anything (radio, computer, tv) and you can wear one and leave the other out to still hear aroud you. Or other portable speakers so it wouldn't be too loud for the neighbors. The patient who is deaf in one ear AND needs really loud music to function and can't use these solutions is going to be fairly rare.

Because of ADA and ADA animals, no one actually can expect that they move into an apartment and there's ZERO chance of any pet neighbors, any more than you can expect no children. (Not sure how that works in 55 and older parks and such....)

Service animals and ESAs are worlds apart. Not even close.

 

[Mass Effect]

To expound on this and what I was saying about mammals needing mammals, I don't know that it's reasonable for someone to be unable to go grocery shopping without their pet/ESA, but I think needing a pet at home emotionally might be very reasonable.

I think for a lot of reasons people might not have an intimate partner or children. I think some people can adapt to this way of being, I think a lot of people struggle and I don't think that's abnormal in any way. I think a lot of the connections we now lack in our society is wholly unnatural and I'm not surprised or think it's pathological people struggle without the connections they would otherwise have in a small tribe with no access to birth control.

People also can forget how isolating in our society having a disability is. It can take people many, many years to build a new social network when they develop a disability. It is more challenging than you might think.

A pet at home could be a small stopgap measure for someone alone, disabled, limited funds, ability to go out, or is in an abusive relationship. Yes, the answer is to leave abusive relationships and find ways to cope and adapt and find people that love you despite your disabilities. Assuming you don't just complete suicide first. It's a harder thing to do when a loving furry companion is staring you in the face.

How is someone crippled by loneliness supposed to find the emotional strength alone to get a better diet, go out and exercise, and make friends? For a lot of patients their therapist and small animal are absolutely seen as safe social contacts to help mitigate loneliness, stabilize their mental health, and hopefully work on other aspects to help their MH. But to tell the depressed person living alone, hey, forget the dog and hit the gym, sounds totally ridiculous to me.

The law has recourse for landlords and neighbors to deal with unruly pets.

I'm just not seeing the harm unless the person becomes overly reliant on an ESA for ADLs.

The harm is to others, including the landlord who doesn't want pets in the building. You're acting as if people with pets have nowhere to go unless these letters exist. That 100% false.

 

[calvnandhobbs68]

Service animals and ESAs are worlds apart. Not even close.

Yes but your same argument applies if you’re approaching it from the standpoint that other tenants have a “right” to not have animals in the building if they thought that’s what they were agreeing to when they signed their lease. If someone’s allergic to dogs, their immune system can’t tell the difference between a service animal and an ESA….

 

[Crayola227]

There are literally plenty of places people who want pets can rent an apartment. Why insist on "keeping greedy landlords from making the housing market a pet-free place or charging the poor pet rent"? Sorry, but no. Landlords are not greedy for wanting to protect their property from damage or provide a place for those who don't want or can't be around pets to live. If animals were so great at curing mental health, there would be more evidence for it. There isn't.

Maybe where you guys live. Where I live it's almost universally a no, we don't have specific "pet free communities" we have a few "pet friendly" because the default is a ban. And the pet friendly ones charge a premium price on overall rent, AND pet rent.

But housing is a problem overall where I am, and especially low income. The effect is that most people get priced out of pet ownership.

Some people think with the fact we domesticated them and overpopulation hasn't been controlled, that there's a moral imperative to our society encouraging ethical animal ownership.

I think unless it becomes an issue of the health of another resident or violating the "peaceful enjoyment" or property damage (which can have financial remedy) that animals shouldn't be banned. We are protecting a so-called "human right" to live in a pet free building (a right that doesn't exist) over other human and animal rights. The property rights of landlords and the health rights of tenants can be and have been addressed.

 

[Crayola227]

Just because it hasn't been taken to court doesn't mean it's not a problem. That logic is just silly.

I mean that the neighbor actually has to be infringed on in some way (anaphylaxis) for it to be a reason to deny the ESA. If the pet is quiet and no allergies are being affected, what is the problem? There are no legal grounds to challenge in that case is my point. If there are legal grounds, then there are grounds and it's challenged. Sounds like a pretty usual state of affairs.

 

[calvnandhobbs68]

I mean, peanut butter is basically outlawed in many pre-schools and elementary school classrooms because kids are allergic. I can't make my kid a PB&J because another kid in another classroom might get a whiff of it and go anaphylactic. It's a pretty congruent analogy to pets in an apartment building. Pretty sure if this goes to court those advocating ESAs are going to lose if the plaintiff has any kind of medical condition...

Again though as was outlined above, there are already provisions for that. If the animal is causing a direct threat to the safety of others, the landlord is not required to accommodate them as an ESA. Simply not wanting animals in your building because you thought you were going to live in an animal free zone despite there being no explicit provision for this in your lease agreement wouldn’t fall under that of course.

I will say that I agree with Crayola as well in terms of it being pretty difficult to rent with animals (which is a whole different socio-economic point). I’ve rented in 3 different cities at this point (one very large city, 2 large metro areas) and every time I went to look, filtering by “allows pets” literally cuts your prospects by at least 50%, if not more. And that’s for a medical student/resident/fellow with ability to pay a pretty decent rent and a car to get around (not having to live near public transit, a particular job site, etc).

 

[Crayola227]

Service animals and ESAs are worlds apart. Not even close.

The only similarity is that the notion you get to rent anywhere and there is ZERO chance of there being an animal allowed under the law, just doesn't exist. Because of ADA, you're already NEVER guaranteed to go almost anywhere and never encounter a dog. So I don't see the real difference with a well behaved ESA. If it isn't well behaved, the protections don't apply.

EDIT: as mentioned, some rentals by number of units a landlord could put in the lease no animals and be able to actually enforce that, in which case you could expect that.

 

[Mass Effect]

Yes but your same argument applies if you’re approaching it from the standpoint that other tenants have a “right” to not have animals in the building if they thought that’s what they were agreeing to when they signed their lease. If someone’s allergic to dogs, their immune system can’t tell the difference between a service animal and an ESA….

But a service animal has a specific purpose and specific reason for being there is the point. And at least in my patient population, the only patients I've had with a service animal already lived in either a house or a place that allowed pets. If someone is blind and their dog is their "eyes," I see a case to be made that the benefit to that individual outweighs the risk of someone moving in with an allergy. But the evidence for an ESA just isn't there and in my experience, these ESA patients are not disabled. They're sad at times, they're anxious at times, and in 99% of the cases, they already have their "pet" and are just moving somewhere that doesn't allow animals so they want a letter. I have yet to see one forced to live somewhere who's asked for an ESA letter.

 

[Mass Effect]

Maybe where you guys live. Where I live it's almost universally a no, we don't have specific "pet free communities" we have a few "pet friendly" because the default is a ban. And the pet friendly ones charge a premium price on overall rent, AND pet rent.

But housing is a problem overall where I am, and especially low income. The effect is that most people get priced out of pet ownership.

Some people think with the fact we domesticated them and overpopulation hasn't been controlled, that there's a moral imperative to our society encouraging ethical animal ownership.

I think unless it becomes an issue of the health of another resident or violating the "peaceful enjoyment" or property damage (which can have financial remedy) that animals shouldn't be banned. We are protecting a so-called "human right" to live in a pet free building (a right that doesn't exist) over other human and animal rights. The property rights of landlords and the health rights of tenants can be and have been addressed.

No, we are not protecting a "so-called human right to live in a pet-free building." The human right is to live on the planet without deathly allergic triggers that can be prevented. Is that not a human right?

There is no human right to own a pet.

As for where you live, that's a shame, but as I and several others on here have said that is not universally true. In many communities in America, there are just as many or more pet-friendly apartments as not.

 

[Mass Effect]

I mean that the neighbor actually has to be infringed on in some way (anaphylaxis) for it to be a reason to deny the ESA. If the pet is quiet and no allergies are being affected, what is the problem? There are no legal grounds to challenge in that case is my point. If there are legal grounds, then there are grounds and it's challenged. Sounds like a pretty usual state of affairs.

You really think there's no problem unless it's anaphylaxis?? That's incredibly narrow-minded and dismissive. There are a slew of reasons that others can be negatively affected by a neighbor's pet, including the example I gave of my patient with PTSD.

 

[Mass Effect]

The only similarity is that the notion you get to rent anywhere and there is ZERO chance of there being an animal allowed under the law, just doesn't exist. Because of ADA, you're already NEVER guaranteed to go almost anywhere and never encounter a dog. So I don't see the real difference with a well behaved ESA. If it isn't well behaved, the protections don't apply.

EDIT: as mentioned, some rentals by number of units a landlord could put in the lease no animals and be able to actually enforce that, in which case you could expect that.

Again, it doesn't sound like you really understand the difference. It isn't about well-behaved and not. A service animal is there for a specific reason; they are trained and act only within the scope of what they were taught. ESAs are random animals.

 

[calvnandhobbs68]

But a service animal has a specific purpose and specific reason for being there is the point. And at least in my patient population, the only patients I've had with a service animal already lived in either a house or a place that allowed pets. If someone is blind and their dog is their "eyes," I see a case to be made that the benefit to that individual outweighs the risk of someone moving in with an allergy. But the evidence for an ESA just isn't there and in my experience, these ESA patients are not disabled. They're sad at times, they're anxious at times, and in 99% of the cases, they already have their "pet" and are just moving somewhere that doesn't allow animals so they want a letter. I have yet to see one forced to live somewhere who's asked for an ESA letter.

Okay so since we're talking specifics (ex. dog moves in next door to a person who is allergic to dogs)...

I have a patient with an extensive trauma history extending through most her childhood and very likely a delusional disorder stemming from that history. She's not overtly psychotic but barely holds it together, was in a homeless shelter for a while, then got a food industry job and was able to find herself a small apartment. She basically has nobody else in this world as she has no contact with her family due to her trauma history and her delusions make it extremely difficult for her to believe that other people are not involved in a grand scheme to further traumatize her. She had a dog and a cat which were allowed at her prior apartment, had them for years, but then had to put them with a foster family through the humane society while she was in the shelter. I was asked to write an ESA letter for her new apartment building, which I did.

Unfortunately she never got the dog and cat back (really through no fault of her own) I won't go into the specifics because that might be too much identifying information. She was doing poorly without having them there, but once she found out what happened to them, she deteriorated to the point that I was borderline hospitalizing her. The animals would typically comfort her and act as grounding objects during times of severe stress when she would have likely illusions/misperceptions that people were watching her in her bedroom and severe nightmares. Do I think that those animals provided a significant amount of emotional support for this person who had basically no other support system? Yes. Which is why I wrote an ESA letter.

However, these animals could never be classified as "service animals" because they do not perform any specific task. So sure, I could say she's disabled but that won't affect the animal classification.

 

[Mass Effect]

Okay so since we're talking specifics (ex. dog moves in next door to a person who is allergic to dogs)...

I have a patient with an extensive trauma history extending through most her childhood and very likely a delusional disorder stemming from that history. She's not overtly psychotic but barely holds it together, was in a homeless shelter for a while, then got a food industry job and was able to find herself a small apartment. She basically has nobody else in this world as she has no contact with her family due to her trauma history and her delusions make it extremely difficult for her to believe that other people are not involved in a grand scheme to further traumatize her. She had a dog and a cat which were allowed at her prior apartment, had them for years, but then had to put them with a foster family through the humane society while she was in the shelter. I was asked to write an ESA letter for her new apartment building, which I did.

Unfortunately she never got the dog and cat back (really through no fault of her own) I won't go into the specifics because that might be too much identifying information. She was doing poorly without having them there, but once she found out what happened to them, she deteriorated to the point that I was borderline hospitalizing her. The animals would typically comfort her and act as grounding objects during times of severe stress when she would have likely illusions/misperceptions that people were watching her in her bedroom and severe nightmares. Do I think that those animals provided a significant amount of emotional support for this person who had basically no other support system? Yes. Which is why I wrote an ESA letter.

However, these animals could never be classified as "service animals" because they do not perform any specific task. So sure, I could say she's disabled but that won't affect the animal classification.

I mean, I'm not going to comment on individual cases because I have never seen a case like the above nor do I anticipate seeing a case like the above. As I said, I have yet to see someone wanting an ESA who is actually disabled. The people who I see who are disabled (big population of schizophrenia) have yet to ask this of me. It's almost always the high-functioning patients with choices in where they live who want their dog for anxiety, but refuse to live in a pet-friendly building even though there is no shortage of them. There is no evidence for an ESA. I stand by that and won't write it. I'm also not the one writing for service animals, but at least in that case, there is data behind it, along with an actual disability evaluation.

 

[calvnandhobbs68]

I mean, I'm not going to comment on individual cases because I have never seen a case like the above nor do I anticipate seeing a case like the above. As I said, I have yet to see someone wanting an ESA who is actually disabled. The people who I see who are disabled (big population of schizophrenia) have yet to ask this of me. It's almost always the high-functioning patients with choices in where they live who want their dog for anxiety, but refuse to live in a pet-friendly building even though there is no shortage of them. There is no evidence for an ESA. I stand by that and won't write it. I'm also not the one writing for service animals, but at least in that case, there is data behind it, along with an actual disability evaluation.

Well the case exists. Cause I saw it. I've also been asked to fill out an ESA form for a college kid with anxiety who wanted her dog to live in her dorm. Hard no. I agree that the cases where an ESA form may be appropriate are rare. But I'd say cases of people with some life-threatening severe dog allergy just happening to have to live next to a person with an animal they're allergic to who happens to be there only because they're an ESA is pretty rare as well.

You're perfectly fine commenting on theoretical individual cases of people with severe dog allergies having to live next to a person with a dog I guess though.

 

[Stagg737]

I mean that the neighbor actually has to be infringed on in some way (anaphylaxis) for it to be a reason to deny the ESA. If the pet is quiet and no allergies are being affected, what is the problem? There are no legal grounds to challenge in that case is my point. If there are legal grounds, then there are grounds and it's challenged. Sounds like a pretty usual state of affairs.

Fair, but look at it as said previously, by writing an ESA letter that says the patient NEEDS the animal to be allowed to live with them, you're essentially prescribing the pet as an ESA. What empirical evidence do you have to back that up in practice? I guess you could argue "off-label" prescribing, but what specifically are you treating? And if it's severe enough that it requires an animal to be present in their living space, why are they not applying for some form of disability?

Again though as was outlined above, there are already provisions for that. If the animal is causing a direct threat to the safety of others, the landlord is not required to accommodate them as an ESA. Simply not wanting animals in your building because you thought you were going to live in an animal free zone despite there being no explicit provision for this in your lease agreement wouldn’t fall under that of course.

I will say that I agree with Crayola as well in terms of it being pretty difficult to rent with animals (which is a whole different socio-economic point). I’ve rented in 3 different cities at this point (one very large city, 2 large metro areas) and every time I went to look, filtering by “allows pets” literally cuts your prospects by at least 50%, if not more. And that’s for a medical student/resident/fellow with ability to pay a pretty decent rent and a car to get around (not having to live near public transit, a particular job site, etc).

And on the other side, a landlord doesn't have to accommodate an "ESA" if it's pet free housing. Are we seriously arguing that living with a pet is a legal right?

However, these animals could never be classified as "service animals" because they do not perform any specific task. So sure, I could say she's disabled but that won't affect the animal classification.

No, but it does protect the patient under the ADA and would legitimize provisions beyond what should be expected for healthy, "normal" individuals. I was actually going to ask why on earth that patient wouldn't be recommended to apply for disability? Seems like a strong argument for SPMI to me....

 

[Mass Effect]

Well the case exists. Cause I saw it. I've also been asked to fill out an ESA form for a college kid with anxiety who wanted her dog to live in her dorm. Hard no. I agree that the cases where an ESA form may be appropriate are rare. But I'd say cases of people with some life-threatening severe dog allergy just happening to have to live next to a person with an animal they're allergic to who happens to be there only because they're an ESA is pretty rare as well.

You're perfectly fine commenting on theoretical individual cases of people with severe dog allergies having to live next to a person with a dog I guess though.

I didn't doubt the case existed. I'm saying that I won't comment on it because I didn't evaluate her so it's next to impossible to say with certainty what I would do. Just based on what you've told me, I'll repeat, there is no evidence for ESAs.

As for life-threatening allergies being rare, that's fine, but regular allergies are not. My nephew is allergic to cats and feels awful around them. He has a right to live without being sick everyday just because some psychiatrist decided Fluffy was the answer to his patient's anxiety.

 

[calvnandhobbs68]

Fair, but look at it as said previously, by writing an ESA letter that says the patient NEEDS the animal to be allowed to live with them, you're essentially prescribing the pet as an ESA. What empirical evidence do you have to back that up in practice? I guess you could argue "off-label" prescribing, but what specifically are you treating? And if it's severe enough that it requires an animal to be present in their living space, why are they not applying for some form of disability?



And on the other side, a landlord doesn't have to accommodate an "ESA" if it's pet free housing. Are we seriously arguing that living with a pet is a legal right?



No, but it does protect the patient under the ADA and would legitimize provisions beyond what should be expected for healthy, "normal" individuals. I was actually going to ask why on earth that patient wouldn't be recommended to apply for disability? Seems like a strong argument for SPMI to me....

She wants to work and wasn't really interested in being on disability but I agree.

Living with a pet is not a legal right. Which is why landlords overall can deny pets. However, living with a service animal or ESA is a legal right, under the Fair Housing Act...which is where this all stems from.

 

[Stagg737]

I mean, I'm not going to comment on individual cases because I have never seen a case like the above nor do I anticipate seeing a case like the above. As I said, I have yet to see someone wanting an ESA who is actually disabled. The people who I see who are disabled (big population of schizophrenia) have yet to ask this of me. It's almost always the high-functioning patients with choices in where they live who want their dog for anxiety, but refuse to live in a pet-friendly building even though there is no shortage of them. There is no evidence for an ESA. I stand by that and won't write it. I'm also not the one writing for service animals, but at least in that case, there is data behind it, along with an actual disability evaluation.

I'll admit, most of my requests for ESA's come from patients with anxiety or personality disorders and are commonly not high-functioning but do get by. Part of why I'm willing to make exceptions after talking to their landlords to assure the policy is just a formality and not in place for

She wants to work and wasn't really interested in being on disability but I agree.

Living with a pet is not a legal right. Which is why landlords overall can deny pets. However, living with a service animal or ESA is a legal right, under the Fair Housing Act...which is where this all stems from.

She can still work and be disabled, they aren't mutually exclusive...

I'll have to read up more, but I've never heard anyone make an argument that an ESA is a legal right and it is certainly not explicitly outlined in the FHA.

 

[Mass Effect]

She wants to work and wasn't really interested in being on disability but I agree.

Living with a pet is not a legal right. Which is why landlords overall can deny pets. However, living with a service animal or ESA is a legal right, under the Fair Housing Act...which is where this all stems from.

If it were a legal right, they couldn't be denied. Yet, we've talked at length about scenarios under which the landlord can deny.

 

[calvnandhobbs68]

I'll admit, most of my requests for ESA's come from patients with anxiety or personality disorders and are commonly not high-functioning but do get by. Part of why I'm willing to make exceptions after talking to their landlords to assure the policy is just a formality and not in place for




She can still work and be disabled, they aren't mutually exclusive...

I'll have to read up more, but I've never heard anyone make an argument that an ESA is a legal right and it is certainly not explicitly outlined in the FHA.

Assistance Animals

www.hud.gov

"Housing providers cannot refuse to make reasonable accommodations in rules, policies, practices, or services when such accommodations may be necessary to afford a person with a disability the equal opportunity to use and enjoy a dwelling."

So, if they can't refuse it...the person basically has a right to that reasonable accommodation. Even if it doesn't explicitly state that.

I agree that she can work and be disabled. By filling out an ESA form, I was in fact asserting that she had a disability. I think everyone should remember that anyway in this conversation (I believe it was mentioned several pages ago at this point). If you're filling out an ESA letter, under the fair housing act, you are asserting that the person has a disability. However, particularly relevant to us:

"Note that under DOJ’s regulations implementing the ADA Amendments Act of 2008, which HUD considers instructive when determining whether a person has a disability under the FHA, some types of impairments will, in virtually all cases, be found to impose a substantial limitation on a major life activity resulting in a determination of a disability.33 Examples include deafness, blindness, intellectual disabilities, partially or completely missing limbs or mobility impairments requiring the use of a wheelchair, autism, cancer, cerebral palsy, diabetes, epilepsy, muscular dystrophy, multiple sclerosis, Human Immunodeficiency Virus (HIV) infection, major depressive disorder, bipolar disorder, post-traumatic stress disorder, traumatic brain injury, obsessive compulsive disorder, and schizophrenia.34"

https://www.hud.gov/sites/dfiles/PA/documents/HUDAsstAnimalNC1-28-2020.pdf

This whole argument basically stems from the fact that there's a proliferation of "providers" and patients who abuse this act by going around getting themselves certified as having a "disability" from some person online who charges them 100 bucks and gives them a form letter.

 

[calvnandhobbs68]

If it were a legal right, they couldn't be denied. Yet, we've talked at length about scenarios under which the landlord can deny.

In a similar way that I have a right to not allow my landlord into my house unless he gives me 24 hours notice but after that, I need to let him in. In the same way I can't yell FIRE in a crowded movie theater and assert I exercised my right to free speech. Rights can have limits. Thus, if your service animal is going around biting people or barking all night long keeping your neighbors awake, you can have limitations on that right.

Who's arguing semantics now

 

[Crayola227]

If it were a legal right, they couldn't be denied. Yet, we've talked at length about scenarios under which the landlord can deny.

Something being a right doesn't mean there aren't circumstances where the right can be denied or suspended.

The landlord has to make reasonable accommodations for an ESA, except for where they could demonstrate a list of things were they don't have to accommodate.

Most disability accommodations have those sorts of exceptions.

 

[Stagg737]

I agree that she can work and be disabled. By filling out an ESA form, I was in fact asserting that she had a disability. I think everyone should remember that anyway in this conversation (I believe it was mentioned several pages ago at this point). If you're filling out an ESA letter, under the fair housing act, you are asserting that the person has a disability.

If you’re claiming they have a legally defined disability that’s different. However, in that case you’re essentially prescribing the animal. Given the poor body of evidence supporting this, imo you’d need to outline specific reasons the individual requires the pet to be allowed in the letter. Honestly, I’m not willing to legally label someone as disabled unless I’ve done a formal eval for that or I can see a formal eval in writing.

some types of impairments will, in virtually all cases, be found to impose a substantial limitation on a major life activity resulting in a determination of a disability

Imo some of the examples given for this statement are ridiculous. I have plenty of patients with MDD, OCD, and TBI who would never meet criteria for disability. Saying nearly all of those carrying one of these diagnoses will lead to a “substantial limitation on a major life activity” is laughable and some writer managed to get a bill with a pretty loose definition of “disability” passed.

 

[calvnandhobbs68]

If you’re claiming they have a legally defined disability that’s different. However, in that case you’re essentially prescribing the animal. Given the poor body of evidence supporting this, imo you’d need to outline specific reasons the individual requires the pet to be allowed in the letter. Honestly, I’m not willing to legally label someone as disabled unless I’ve done a formal eval for that or I can see a formal eval in writing.



Imo some of the examples given for this statement are ridiculous. I have plenty of patients with MDD, OCD, and TBI who would never meet criteria for disability. Saying nearly all of those carrying one of these diagnoses will lead to a “substantial limitation on a major life activity” is laughable and some writer managed to get a bill with a pretty loose definition of “disability” passed.

Well yeah we can argue about the fact that this may be overly broad but that’s neither here nor there…that’s straight from the HUD guidance document. There are also plenty of people with HIV or diabetes who function just fine day to day as well.

This is why people should be familiar with what the actual guidance is. On the one hand, there’s people who don’t realize that writing a letter for an ESA is also asserting that a person has a disability. On the other hand, there’s people that don’t realize that that’s actually a pretty low bar to pass to determine someone has a disability based on the document I linked to.

 

[Stagg737]

Well yeah we can argue about the fact that this may be overly broad but that’s neither here nor there…that’s straight from the HUD guidance document. There are also plenty of people with HIV or diabetes who function just fine day to day as well.

This is why people should be familiar with what the actual guidance is. On the one hand, there’s people who don’t realize that writing a letter for an ESA is also asserting that a person has a disability. On the other hand, there’s people that don’t realize that that’s actually a pretty low bar to pass to determine someone has a disability based on the document I linked to.

So then when a disability letter is written it should only need to include the specific diagnosis in that list they are being treated for, not that we are recommending that a patient be allowed to have a pet because if they carry one of those diagnoses they can legally bring the pet. What's the point at all in "recommending" that a pet be allowed to live with them other than to shift liability and provide documentation that you're basically "prescribing" an ESA?

If it's truly a legal issue, the only thing we should need to do is provide a letter saying we're treating them for X condition on that list. They could argue that they can legally bring an ESA with them because it helps their diabetes, are we really not seeing a problem with interjecting ourselves and actively promoting ESAs excessively?

 

[calvnandhobbs68]

So then when a disability letter is written it should only need to include the specific diagnosis in that list they are being treated for, not that we are recommending that a patient be allowed to have a pet because if they carry one of those diagnoses they can legally bring the pet. What's the point at all in "recommending" that a pet be allowed to live with them other than to shift liability and provide documentation that you're basically "prescribing" an ESA?

If it's truly a legal issue, the only thing we should need to do is provide a letter saying we're treating them for X condition on that list. They could argue that they can legally bring an ESA with them because it helps their diabetes, are we really not seeing a problem with interjecting ourselves and actively promoting ESAs excessively?

No I agree that it seems like most of this is designed to try to shift liability onto us (I always try to mitigate this by saying I cannot attest to the training or safety of this animal when I fill these forms out). You do have to comment on the fact that you believe the animal is theraputic in some way.

It's not correct that you should put down the specific diagnosis that the patient is being treated for. From the document:

"Housing providers are not entitled to know an individual’s diagnosis"

Although some patients may be fine with sharing their diagnosis, they don't have to and we shouldn't put the diagnosis down unless the patient consents to that. All that's actually required is information stating there is a diagnosis which results in a disability.

"general to the condition but specific as to the individual with a disability and the assistance or therapeutic emotional support provided by the animal."

You do have to make some comment as to the ESA or service animal having some kind of therapeutic support or specific assistance they provide, which could of course give some insight into what kind of disability the person has.

 

[Sushirolls]

Something I've been reflecting on lately...

We choose to fill or not fill various prescriptions...

So in essence, if some one comes into the office with a pet, citing another clinicians ESA letter, can we declare "canceled" "not appropriate" "letter deleted" or something along those lines, and tell them to take the animal out and not bring it back?

 

[WisNeuro]

Something I've been reflecting on lately...

We choose to fill or not fill various prescriptions...

So in essence, if some one comes into the office with a pet, citing another clinicians ESA letter, can we declare "canceled" "not appropriate" "letter deleted" or something along those lines, and tell them to take the animal out and not bring it back?

I mean, an ESA "prescription" has about the same validity as a prescriber saying that someone needs to carry around a wacky wavy inflatable tube man for their mental health, and I assume we'd ask them not to bring that into the office. So, why not?

 

[Sushirolls]

I vaguely recall, and think buried in early pages of this thread are the nuances of ADA protections allowing people to bring them almost anywhere and if turned away they can file lawsuits. That would be the concern.

 

[WisNeuro]

I vaguely recall, and think buried in early pages of this thread are the nuances of ADA protections allowing people to bring them almost anywhere and if turned away they can file lawsuits. That would be the concern.

Does anyone have an update to these laws? I thought the laws pertained only to actual service animals or psychiatric service animals, I didn't think ESAs were included in the broad protections.

 

[PsyDr]

Something I've been reflecting on lately...

We choose to fill or not fill various prescriptions...

So in essence, if some one comes into the office with a pet, citing another clinicians ESA letter, can we declare "canceled" "not appropriate" "letter deleted" or something along those lines, and tell them to take the animal out and not bring it back.

1) You don't have to "cancel" the letter, because ESA laws never applied to you in the first place. If it's an ESA, the governing federal laws are limited to issues of housing and airplanes. Unless you have a very strange office, that doesn't apply to you.

2) If it is a "service animal", you must allow it. But, service animals can ONLY be dogs or mini-horses. And they must be trained to perform a specific task. "Calming" does not count.


Emotional Support Animal
a. Covered under the Fair Housing Act and the Air Carrier Access Act
b. The law only applies to qualified housing or an actively flying airplane
c. Can be any animal. Airlines can have discretion on exotics.
d. Does not have to be trained to do any task
e. Airlines have the right to ask if the animal can delay urination.

Service Animal
a. Covered under the American with Disabilities Act and the Air Carrier Access Act
b. Offers broad protection across multiple settings including the OR.
c. Can only be a dog or mini-horse.
d. The dog or horse must be trained to perform a task. "Calming" does not count as a trained task. "Sensing a panic attack before onset and doing something about it" does count.
e. You can only ask the animal to leave if the animal becomes disruptive. Allergies do not count.
f. The ADA website has questions you can ask to "verify" that it is a service animal.

 

[WisNeuro]

An Emotional Support Animal — or ESA for short — is an animal, usually, a dog or cat (most often a dog) whose very presence tends to calm or have therapeutic effects upon its owner in times of stress and difficulty. Traditionally, an Emotional Support Animal has been trained by a professional trainer to be a support animal, but recent laws have changed allowing many more pets to be deemed an ESA which were not designated as such previously. With numerous benefits for health, Emotional Support Animals serve two areas under federal laws.

They are furry benzos, whose "health benefits" above and beyond having a pet at home, have not been empirically established. And, according to what we do know about safety cues, they are likely counter productive/iatrogenic in many MH conditions.

 

[Crayola227]

They are furry benzos, whose "health benefits" above and beyond having a pet at home, have not been empirically established. And, according to what we do know about safety cues, they are likely counter productive/iatrogenic in many MH conditions.

omg furry benzo what

while I appreciate what you're trying to say, I'm not sure pets are as bad for people as benzos

 

[WisNeuro]

omg furry benzo what

while I appreciate what you're trying to say, I'm not sure pets are as bad for people as benzos

Not pets, ESAs. In terms of some of the more supported theories of anxiety and its reinforcement, the constant presence of a safety cue will only reinforce and strengthen certain anxiety symptoms. So, in this aspect, they are very much alike.

 

[bobby pen]

I live in a high cost of living area and currently work in community health. Unfortunately what I’ve noticed is that most section 8 housing etc. don’t allow pets. Most my patients have had dogs or cats that have been with them 8-9-10 years but when they have to move, they can’t take them with them bc housing won’t allow it (landlord is selling the house for profit or apt complex is changing ownership or where their going just won’t allow pets and they can’t find other housing etc) And without their ESA letters..they’ll have to give them up to shelters, some of which are kill. Now giving up your pet/companion you’ve had for 10 years can be pretty detrimental to the mental health of these patients, especially if they know they may be euthanized. So, I write the letter to let them keep their companions bc I know this will be beneficial for them.
I don’t concern myself with hypothetical allergies in an apt setting, or the concerns of landlords and real estate moguls might be put out(think we’ve respected that enough from 2016-2020 as one was president). I worry about my patient…and what they need and what’s best for them. I am honestly disheartened to read what’s on this forum and the lack of compassion for people and their relationship with their pets.
I don’t write for them to be on planes..but I do write ESA letters to let them continue to be with each other despite some unfair rules that seem to target a lot of my patients.

 

[WisNeuro]

So, the bottom line seems to be that some providers are willing to write these letters purely to cure perceived societal ills? If you don't want to practice medicine, that's fine, go into politics. I'll stick to empirically supported interventions, that conveniently also don't trample the rights of others. If anything, I'm disheartened by the embracing of pseudoscience in this context so a provider can feel better about themselves.

 

[FlowRate]

community health

There are certainly a few archetypes of CMHC patient who I might relax my stance on ESA's for.

The vast majority of my patient demographic are trying to get out of paying pet fees. This is an extremely pet-friendly city and allowing pets is considered a competitive draw for apt buildings. They just don't want to pay for the added wear their pet will inevitably place on their new apt.

 

[birchswing]

You meat-eaters are going to change your minds when they start requiring doctors' notes to access to nutritional support animals.

 

[anonperson]

I live in a high cost of living area and currently work in community health. Unfortunately what I’ve noticed is that most section 8 housing etc. don’t allow pets. Most my patients have had dogs or cats that have been with them 8-9-10 years but when they have to move, they can’t take them with them bc housing won’t allow it (landlord is selling the house for profit or apt complex is changing ownership or where their going just won’t allow pets and they can’t find other housing etc) And without their ESA letters..they’ll have to give them up to shelters, some of which are kill. Now giving up your pet/companion you’ve had for 10 years can be pretty detrimental to the mental health of these patients, especially if they know they may be euthanized. So, I write the letter to let them keep their companions bc I know this will be beneficial for them.
I don’t concern myself with hypothetical allergies in an apt setting, or the concerns of landlords and real estate moguls might be put out(think we’ve respected that enough from 2016-2020 as one was president). I worry about my patient…and what they need and what’s best for them. I am honestly disheartened to read what’s on this forum and the lack of compassion for people and their relationship with their pets.
I don’t write for them to be on planes..but I do write ESA letters to let them continue to be with each other despite some unfair rules that seem to target a lot of my patients.

If you feel so strongly about emotional support animals why wouldn't you write a letter recommending your patient have them in an airplane? Flying is a stressful situation.

Why this vague distinction? Is it because the landlord can't really do anything about it?

 

[Sushirolls]

If some one is so poor that they need Section 8 housing why are they spending money on a pet? A pet is a luxury not a right. Pets cost money: vet bills, food, medicine, litter boxes, leashes, etc. In some ways, its theft from public coffers by subsidizing housing that perhaps could have been afforded had improved finances been realized with no pet responsibilities...

Entitlement to pets in America is just another symptom of the overall entitlement trends that are rising.

The posts by Bobby Pen also exemplify entitlement from a socialist perspective; you are enabling people by forcing your beliefs of entitlement on property owners.

Shameful.

 

[Stagg737]

If some one is so poor that they need Section 8 housing why are they spending money on a pet? A pet is a luxury not a right. Pets cost money: vet bills, food, medicine, litter boxes, leashes, etc. In some ways, its theft from public coffers by subsidizing housing that perhaps could have been afforded had improved finances been realized with no pet responsibilities...

Entitlement to pets in America is just another symptom of the overall entitlement trends that are rising.

The posts by Bobby Pen also exemplify entitlement from a socialist perspective; you are enabling people by forcing your beliefs of entitlement on property owners.

Shameful.

By the same logic, why stop at pets? Why not include children? Kids cost tons of money and god knows many of these kids end up needing far more help because of these parents than if they were provided for through other means or removed.

Obviously hyperbole here, but I don't think all situations are equal. I don't have a problem with a patient who's had a pet forever and just needs a letter saying that loss of the animal could cause distress or exacerbation of their condition with something like what was posted earlier saying they have X condition and they feel the pet is helpful without saying it's medically necessary.

I do agree that writing letters saying a pet is psychologically necessary is inappropriate and goes beyond the areas of our expertise as physicians. However, I don't think it's unreasonable for patients to request letters in many situations, the reactions to our answers regarding whether we believe it is appropriate is where things can get very unreasonable and inappropriate.

 

[erg923]

I live in a high cost of living area and currently work in community health. Unfortunately what I’ve noticed is that most section 8 housing etc. don’t allow pets. Most my patients have had dogs or cats that have been with them 8-9-10 years but when they have to move, they can’t take them with them bc housing won’t allow it (landlord is selling the house for profit or apt complex is changing ownership or where their going just won’t allow pets and they can’t find other housing etc) And without their ESA letters..they’ll have to give them up to shelters, some of which are kill. Now giving up your pet/companion you’ve had for 10 years can be pretty detrimental to the mental health of these patients, especially if they know they may be euthanized. So, I write the letter to let them keep their companions bc I know this will be beneficial for them.
I don’t concern myself with hypothetical allergies in an apt setting, or the concerns of landlords and real estate moguls might be put out(think we’ve respected that enough from 2016-2020 as one was president). I worry about my patient…and what they need and what’s best for them. I am honestly disheartened to read what’s on this forum and the lack of compassion for people and their relationship with their pets.
I don’t write for them to be on planes..but I do write ESA letters to let them continue to be with each other despite some unfair rules that seem to target a lot of my patients.

Who the hell are you to tell me what to do with my personally owned property? While it might feel great and mighty to "not concern yourself" with the rights of anyone but your patients....I would assert that this is nothing more than selfish and ridiculous nonsense.

I (we) would., again..... assert behavioral/psychological principals that discourage reinforcement of anxiety prone behaviors.

 

[mistafab]

I am limited in my experience with this and am just a PGY2.

I agree that pets could be helpful for patients.

However, I would not write a letter in support of an emotional support animal. It appears to me unethical. An animal may help the patient, but the fact that they require a letter in order to break some rule (i.e. traveling, renting, etc) tells me my act may in fact cause harm to others. Pet ownership is great, harming people is not. I am not in the business of harming people.

I couldn't stand behind doing something like that.

 

[FlowRate]

I don't have a problem with a patient who's had a pet forever and just needs a letter saying that loss of the animal could cause distress or exacerbation of their condition with something like what was posted earlier saying they have X condition and they feel the pet is helpful without saying it's medically necessary.

I think I posted about it earlier in this thread or a related one but that's what I used to do until I realized what I was required to do by state law/statute, which is make a determination regarding whether the patient has a "disability and associated disability related need" for the animal.

Had a patient fire me this week for stating that I would not provide an ESA letter. I probably could have phrased the portal reply better, other patients had responded neutrally/positively to the simple statement that it's not something I provide but she chose to interpret it differently. Trying to decide how I want to word future responses to such requests or if I'm going to keep the very simple phrasing. I don't want to get into a lengthy explanation with patients about it.

Not writing them is actually also not in line with state law/statute. The law says I'm obligated to make a written determination either way. I don't know that patients would appreciate a letter from me stating there was "insufficient evidence to determine whether the patient has disability-related need for an animal."

 

[PsyDr]

I live in a high cost of living area and currently work in community health. Unfortunately what I’ve noticed is that most section 8 housing etc. don’t allow pets. Most my patients have had dogs or cats that have been with them 8-9-10 years but when they have to move, they can’t take them with them bc housing won’t allow it (landlord is selling the house for profit or apt complex is changing ownership or where their going just won’t allow pets and they can’t find other housing etc) And without their ESA letters..they’ll have to give them up to shelters, some of which are kill. Now giving up your pet/companion you’ve had for 10 years can be pretty detrimental to the mental health of these patients, especially if they know they may be euthanized. So, I write the letter to let them keep their companions bc I know this will be beneficial for them.
I don’t concern myself with hypothetical allergies in an apt setting, or the concerns of landlords and real estate moguls might be put out(think we’ve respected that enough from 2016-2020 as one was president). I worry about my patient…and what they need and what’s best for them. I am honestly disheartened to read what’s on this forum and the lack of compassion for people and their relationship with their pets.
I don’t write for them to be on planes..but I do write ESA letters to let them continue to be with each other despite some unfair rules that seem to target a lot of my patients.

Which other standards do you "not concern yourself for", "for the best of your patients"? Testify because jail would be bad for the patient?

 

[VA Hopeful Dr]

I think I posted about it earlier in this thread or a related one but that's what I used to do until I realized what I was required to do by state law/statute, which is make a determination regarding whether the patient has a "disability and associated disability related need" for the animal.

Had a patient fire me this week for stating that I would not provide an ESA letter. I probably could have phrased the portal reply better, other patients had responded neutrally/positively to the simple statement that it's not something I provide but she chose to interpret it differently. Trying to decide how I want to word future responses to such requests or if I'm going to keep the very simple phrasing. I don't want to get into a lengthy explanation with patients about it.

Not writing them is actually also not in line with state law/statute. The law says I'm obligated to make a written determination either way. I don't know that patients would appreciate a letter from me stating there was "insufficient evidence to determine whether the patient has disability-related need for an animal."

Wait, do what now?

If a patient asks for this you are required to provide a statement about it? What awful state do you live in?

 

[erg923]

Wait, do what now?

If a patient asks for this you are required to provide a statement about it? What awful state do you live in?

Im sure da cops will get right on that...

 

[Alemo]

Not writing them is actually also not in line with state law/statute. The law says I'm obligated to make a written determination either way.

It seems highly highly highly unlikely that (in whatever state you practice) disability evaluations are something physicians are legally obligated to provide.

Edit: After reviewing SSA.gov regulations, it looks like you can refuse to do the evaluation (potentially with good reason as the treating physician is not quite objective in disability assessment) and the SSA will pay for an independent examination.