ESA Letter Policy

As a PMHNP, my policy for writing an emotional support animal (ESA) letter for established patient is as follows:

Eligibility and Criteria

Established Clients: ESA letters will only be provided to established clients who have been under the care of a mental health practitioner within the practice for a reasonable period (>30 days), allowing the practitioner to assess the client's mental health condition and the potential benefits of an emotional support animal.
Mental Health Condition: The client must have a mental health condition that has been thoroughly evaluated by a mental health provider and that substantially limits a major life activity, such as severe depression, chronic anxiety, PTSD, or learning disorders, as assessed by the healthcare professional. The patient will have a conversation with the provider to discuss how their animal provides them with emotional support.

Letter Content

Format: The letter will be printed on the provider's professional letterhead with provider's name, signature, license number, effective date of license, and provider number.
Clinical Justification: The letter will include a clinical justification for the need for an emotional support animal based on the patient's mental health condition and the potential therapeutic benefits.
Compliance with Laws: The letter will comply with relevant federal, state, and local laws, and will be in accordance with the evolving area of law related to emotional support animals
No Vouching for Training, Temperament, or Behavior: The ESA letter will not vouch for the training, temperament, or behavior of the animal, as this is not within the scope of the mental health nurse practitioner's expertise. Furthermore, an emotional support animal does not qualify as a service animal, and that misrepresenting the support animal as a service animal is against the law.

About Emotional Support Animals (ESA)

What is an ESA?

Emotional support animals (ESAs) are animals that provide therapeutic benefits such as emotional support, comfort, and companionship to people with mental health or psychiatric disabilities. ESAs are not considered service animals, but they are also not considered pets and are generally not restricted by the type of animal. Any domesticated animal may be considered an ESA, such as cats, dogs, mice, rabbits, birds, hedgehogs, rats, minipigs, and ferrets etc. However, an ESA must be able to be manageable in public and not create a nuisance. ESAs do not perform specific tasks, but their presence can relieve the symptoms associated with a person's serious mental health condition. To legally have an ESA, the owner must be considered to have a qualifying mental health or psychiatric disability by a licensed mental health professional, which is documented by a properly formatted prescription letter. ESAs can provide joy, companionship, and emotional support to people with mental health concerns.

ESA Rights by U.S. HUD

What is the difference between an ESA, Service, and Therapy Animal?

Distinguishing between Emotional Support Animals (ESAs), Service Animals, and Therapy Dogs is crucial. ESAs encompass a wide range of animals or pets that offer emotional and therapeutic support to individuals facing emotional and mental health conditions or disabilities. They enjoy legal protection under Federal Law and the Fair Housing Act, and unlike Service Animals, they are not required to undergo specific training to serve as emotional support animals.

Service animals, predominantly dogs, are rigorously trained and certified to provide crucial services to individuals with conditions like medical alerts, seizure disorders, PTSD, and mobility challenges, such as assisting those in wheelchairs. They can also be invaluable for individuals on the autism spectrum and may even serve as allergy alert animals. Both Federal Law and the American Disabilities Act grant service animals full access to public places, recognizing their indispensable role.

In contrast, Therapy Dogs undergo specialized training to offer comfort and affection to individuals in settings such as nursing homes, rehabilitation facilities, hospitals, and some schools. However, it's essential to note that Therapy Dogs do not share the same level of protected access rights enjoyed by ESAs and Service Animals, as their primary role is to provide emotional support rather than perform specific tasks.

ADA: Service Animals

Additional Resources

American Kennel Club: Canine Good Citizen

While I do not vouch for animal training, temperament or behavior, as a responsible citizen it is important to ensure that our beloved dogs are trained with proper manners, even if they are not being trained to be service or therapy dog. This helps to ensure public and personal safety, as well as to build a strong trust between you and your furry friend.

For those wishing to have their dogs as prescribed ESAs, while it is not a requirement, I highly recommend looking into Canine Good Citizen™ certification. Give you and your dog confidence with American Kennel Club training and Canine Good Citizen certification. The American Kennel Club (AKC) created the Canine Good Citizen™ (CGC) program: an expert-made training program designed to help you and your dog be the best you can be–together.

Canine Good Citizen™ is a 10-skills test that teaches good manners to dogs and responsible dog ownership to their owners, it is NOT service dog training. To learn more about this amazing program visit the website below.

AKC- CGC

Therapy Dog Volunteer: Fostering Personal and Community Well-being

Volunteering, particularly with your beloved dog or cat, offers significant benefits for both personal and community mental health. Research has shown that volunteering can decrease stress levels, combat depression, and prevent feelings of isolation, leading to improved overall health and satisfaction with life. Volunteering activates the reward center in the brain, releasing serotonin, dopamine, and endorphins, which contribute to a sense of well-being and improved mental health. Additionally, volunteering provides a sense of purpose, reduces stress, and increases positive, relaxed feelings by releasing dopamine, ultimately fostering a strong sense of meaning and appreciation. Engaging in volunteer activities, including pet therapy, not only benefits the individual volunteer but also contributes to building a supportive and connected community, ultimately improving mental health on a broader scale. If you are interested in learning more about how you and your dog can become pet therapy volunteers please visit the following website:

Become a Pet Therapy Volunteer

BENEFITS OF ANIMAL-ASSISTED ACTIVITIES

Animal-assisted activities and therapies offer a multitude of benefits for mental and physical well-being. Interacting with animals has been shown to reduce stress, anxiety, and depression, while promoting relaxation and a sense of comfort. The release of hormones such as serotonin, prolactin, and oxytocin during these interactions can elevate moods and contribute to improved mental health. Additionally, animal-assisted activities provide mental stimulation, assist in memory recall, and can act as catalysts in the therapy process. On a physical level, these activities have been linked to lowered blood pressure, improved cardiovascular health, reduced pain, and increased motivation for exercise. Furthermore, for children with autism, animal-assisted therapy has been found to enhance language use and social interaction during therapy sessions. Overall, the positive impact of animal-assisted activities and therapies on mental and physical well-being is well-documented and continues to be an area of active research.

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