For centuries, animals, especially dogs, have assisted humans in a variety of ways in their daily lives. Animals that assist people with disabilities fall into 2 broad categories: disability service animals, and emotional support animals (ESAs). Often there is confusion in how these categories differ because of the animal’s role and the laws related to them.
This article describes the differences between disability service animals and ESAs, and outlines the forensic and ethical concerns you should consider before agreeing to write a letter for a patient outlining their need for a disability service animal or ESA. A letter may protect a patient and their service animal or ESA in situations where laws and regulations typically prohibit animals, such as on a flight or when renting an apartment or house. Note that a description of how to conduct the formal patient evaluation before writing a verification letter is beyond the scope of this article.
The differences between disability service animals and ESAs
Purpose and training. Disability service animals, or service animals, are dogs of any breed (and in some cases miniature horses) that are specially trained to perform tasks for an individual with a disability (physical, sensory, psychiatric, intellectual, or other mental disability).1-3 These tasks must be directly related to the individual’s disability.1,2 On the other hand, ESAs, which can be any species of animal, provide support and minimize the impact of an individual’s emotional or psychological disability based on their presence alone. Unlike disability service animals, ESAs are not trained to perform a specific task or duty.2,3
There is no legal requirement for service animals to know specific commands, and professional training is not required—individuals can train the animals themselves.1 Service animals, mainly dogs, can be trained to perform numerous tasks, including4:
- attending to an individual’s mobility and activities of daily living
- guiding an individual who is deaf or hearing impaired
- helping to remind an individual to take their medications
- assisting an individual during and/or after a seizure
- alerting individuals with diabetes in advance of low or high blood sugar episodes
- supporting an individual with autism
- assisting an individual with a psychiatric or mental disability
- 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 psychiatric service dogs, whose handlers may not have a visible disability (Box 11,5).
Box 1
Is it a service dog, or just a pet?
In the United States, there is no national service dog certification program—meaning there is no official test that a dog has to pass in order to obtain formal recognition as a service animal—nor is there a central and mandatory service dog registry.5 Instead, service dog verification works through an honor system, which can be problematic.5 In many states, misrepresenting one’s dog as a service dog is considered a misdemeanor.5 Unfortunately, other than the guidance set forth by the Americans with Disabilities Act, there are no criteria by which one can recognize a genuine service dog vs one being passed off as a service dog.5
In situations in public settings where it is not obvious or there’s doubt that the dog is a service animal (such as when a person visits a restaurant or store), employees are not allowed to request documentation for the dog, require the dog demonstrate its task, or inquire about the nature of the person’s disability.1
However, they can ask 2 questions1:
1. Is the animal required because of a disability?
2. What work or task has the animal been trained to perform?
Legal protections. Under the Americans with Disabilities Act (ADA), individuals with disabilities can bring their service animals into buildings or facilities where members of the public, program participants, clients, customers, patrons, or invitees are allowed.2 This does not include private clubs, religious organizations, or places of worship that are not open to the public.6,7 ESAs do not qualify as service animals under the ADA and are not given the same legal accommodations as service animals.1,3 Although ESAs were initially covered by the Air Carrier Access Act, they are no longer allowed in aircraft cabins after the US Department of Transportation revised this Act’s regulations in December 2020. ESAs are covered under the Fair Housing Act. Box 21-3,6-15 further discusses these laws and protections.
Evidence. In 1998, Dogs for Good (formerly Dogs for the Disabled), an organization based in the United Kingdom, conducted a survey that assessed the satisfaction of owners who were provided with trained assistance dogs.16 The results suggested that service dogs improved their owners’ mobility and helped ease the completion of tasks, thereby helping their owners integrate further on a society level and gain a strong bond with their animal.16 Another survey compared quality of life scores of individuals who owned a service dog vs individuals who were eligible to receive a dog, but did not yet have one.17 It found that service animals were able to help their owners gain a greater degree of freedom and enhance their ability to participate in everyday outings or tasks that may otherwise have been a struggle, or impossible, if the owner were alone.17 In addition to boosting confidence, self-esteem, and improving social integration, service dogs have been shown to improve their owners’ quality of life.17
Due to the difficulty in reconciling inconsistent definitions for ESAs, there is limited high-quality data pertaining to the potential benefits and risks of ESAs.9 Currently, ESAs are not an evidence-based treatment for psychiatric disorders. To date, a handful of small studies have focused on ESAs. However, data from actual tests of the clinical risks and benefits of ESAs do not exist.9 In practice, ESAs are equivalent to pets. It stands to reason that similar to pets, ESAs could reduce loneliness, improve life satisfaction, and provide a sense of well-being.9 A systematic review suggested that pets provide benefits to patients with mental health conditions “through the intensity of connectivity with their owners and the contribution they make to emotional support in times of crises together with their ability to help manage symptoms when they arise.”18 In response to a congressional mandate, the US Department of Veterans Affairs launched a multi-site study from December 2014 to June 2019 to examine how limitations on activity and quality of life in veterans with posttraumatic stress disorder are impacted by the provision of a service dog vs an emotional support dog.19 As of October 14, 2021, results had not been published.19
Continue to: What’s in a disability service animal/ESA letter?