Many therapists are unsure what to do when their client asks them to write an Emotional Support Animal Letter. The Ohio Counselor, Social Work, and Marriage and Family Therapist Board put out guidance that alerted clinicians that they should only write letters if they have the experience and training to do so:
CSWMFT Board licensees should not provide letters of support for ESAs or service animals unless they have education, training, and experience in assessing clients to determine the need for an ESA or service animal. Such training and experience should include understanding the needs of the human client as well as the needs and capacity of the proposed ESA or service animal. -Ohio CSWMFT Board 9/2019
One thing that has become a popular response for clinicians, is to direct clients to online resources to obtain a letter through an "ESA Registration". There was a a conversation this week in one of the Ohio based therapist facebook groups where one therapist asked where to send clients to get an Emotional Support Letter and multiple therapists posted links to "Register your ESA" websites. These websites "promise" to get your pet "registered" as an ESA. These websites are scams and are created to get money from the client by leading them on with the idea that they have an "official" letter registering their animal. The reality is, these letters are often not ethical, do not hold up in court, and can land a clinician in trouble.
The biggest issue with fake ESA letter websites is that it treats the animal like a piece of property. It does not consider that they have fears, thoughts, and motivation. Unlike getting the client linked with social supports like food stamps, this intervention requires another living being that has needs, motivations, and fears. The Emotional Support Letter writing process requires collaboration between the therapist, client, and pet. A trained clinician includes the voice of the pet. The clinician also recognizes that an ESA letter puts a responsibility on a party that can't consent in the same way people can. These websites often do not even consider or assess the relationship between the client nor the animal's voice. The emotional state of the animal is often not considered, leading to letters saying that the animal is ok to be on an airplane, which is not prepared to do so, which leads to high risk situations and extreme stress on the animal. This is a topic I will talk more about in a later blog and in my class The Basics of ESA Letter Writing.
Here are a few more things to think about before you direct a client to go online to obtain an ESA letter:
Animals that owners claim their pets are Emotional Support Animals have been in the news a lot lately. In 2018 when a woman tried to board a United flight with her "Emotional Support Peacock". It did not stop at the peacock. In fact, many passangers have attempted to get their "emotional support animal" onto a plane. Many of these animals were not trained to be able to handle being in stressful situations, and end up on the news for acts of aggression or fear. In 2019 a man sued Delta after an Emotional Support Animal bit him and accused the airline of neglect. Unlike service dogs, ESAs do not require any formal training by law, and it ends up putting animals in situations where they act out because they do not understand what is going on. In 2020 the Department of Transportation banned emotional support animals from the same privileges as service animals on flights. The ban was due to the increase in "Emotional Support Animals" that disrupt flights and create issues on the plane, that put passengers, staff, and the animal at risk.
Emotional Support Animal letter writing is unregulated. The DOT found was that people would obtain letters from online "registrations" or convince their therapist to write a letter for them (even if the therapist had never seen the client and pet interact). This didn't just affect airlines. States have started to push legislation to stop the spread of fake ESAs. In 2021 California proposed and enacted a law against fraudulant ESAs. In light of the move to try to curb illegitimate Emotional Support Animals, clinicians are starting to see more scrutiny. Due to the increase in fake ESAs, there is an increase in letters being questioned for their legitimacy.
A few online websites offer clients an ESA letter written by a real licensed clinician. The issue with many of these is that the clinician sometimes is not in the state as the client. In a California case a therapist wrote an ESA letter for a client who did not reside in the state of California. The client obtained the letter after filling out an online questionnaire. In the letter, the therapist stated the client was in their care, although during the investigation it was found they had never met (either through telehealth or in person). When the client attempted to apply for housing, the landlord noticed the letter was from California and reported it to the board. The clinician was disciplined for practicing in a state they did not have a license in and the therapist "had not done proper assessment" before issuing the ESA letter.
It is important as clinicians that we guide our clients to resources that will do no harm and provide ethical care. No clinician wants to be responsible for their client running into issues because the resource they were given was not ethical or legal. Here are a few other signs that the ESA letter service is a scam:
1- The page says you can "Register" or "Certify" your ESA
Emotional Support Animals are unregulated. There is no legal or legit registration for ESAs anywhere in the United States. Any website that claims a client can register an ESA is out to take the client's money. A registration number, "Certification" or vest will not make the animal an Emotional Support Animal, only a letter written by a trained perscriber whom the client is under their care. Hud released guidance on this, which can be read here.
2- The Service Offers "One Time Assessments"
Best practices dictate that the ESA letter needs to be written by a therapist, doctor, or counselor that the client is actively seeing. Emotional Support Animals are an intervention. An ESA letter is written to help decrease the client's mental health symptoms that are impacting their daily life. A trained ESA letter writer uses best practices, which dictate that ESAs need to be part of a treatment plan, with check-ins, and measuring of progress.
How to Tell If It is Legit?
There are so many fake "quick and easy" options for cilents to fall trap to. A client may come into a clinician's office stating they already have an ESA letter, or if you say no they may go online to "find one themselves". It can be really hard to tell what is a legit letter and what is not. Here are a few quick things to help you know if the letter is valid:
1- Does the Letter have a Date?
Best practices dictate that Emotional Support Letters are an intervention used to help decrease symptoms for a client and are built into a treatment plan. Just like any treatment plan, they need a date of start and end which is included with the dates of treatment. Expiration dates are a signal for the clinician who wrote it to review and write a new letter if needed.
2- Clinician Signature and Location
Is the letter signed by a licensed clinician within the state the client resides? Emotional Support Animal Letters are only legal if signed by a licensed clinician or doctor. They also need to be licensed in the location of the client at the time it was written.
3- Was the Client Being Seen By the Clinician?
If the client has never seen, met, or worked with this clinician for more then one session, this might be a sign the letter is not legitimate. (There is an exception if the letter was written as part of a forensic interview for disability dertermination, but those cases are rare.) Best practice dictates that the client needs to have been seen and under the continued care of the clinician writing it.
There is a need for clinicians to become trained in how to ethically write these letters. Letters written in unethical ways put clients and their animals at risk. It also harms folks who really need them and creates a barrier.
Interested in becoming a clinician trained in writing Emotional Support Animal Letters? Visit our course page and sign up.
Therapist Scrutinized for Writing ESA Letter https://www.simplepractice.com/blog/emotional-support-animal-letter/
California Assembly Bill No, 468 https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=202120220AB468