Ann Tran-Lien, JD
Staff Attorney
The Therapist
January/February 2013 

Emotional support animals can offer support and therapeutic benefits to individuals with mental or psychological disabilities. Federal and California laws recognize emotional support animals as reasonable accommodations for people with disabilities for purposes of housing and travel. Letters from health care and mental health providers are generally requested to show that the animal provides a disability-related benefit to the individual. Therefore, it is becoming more common for clients to ask their therapists to provide such documentation. This article will provide a brief summary of the relevant laws and discussion of some legal and ethical issues for therapists to consider when responding to this type of request.

What is an Emotional Support Animal?
Assistance animals or emotional support animals are defined as animals that work, provide assistance, or perform tasks for the benefit of a person with a disability, or animals that provide emotional support that alleviates one or more identified symptoms or effects of a person’s disability.¹ Emotional support animals perform many disability-related functions, including, but not limited to, providing emotional support to persons with disabilities who have a disability-related need for such support. Emotional support animals are not generally trained to perform specific tasks to assist persons with a psychiatric disability, but they must provide a disability-related benefit to such individuals.

It is important to note the distinction between emotional support animals and service animals. Service animals are defined as “any dog that is individually trained to do work or perform tasks for the benefit of an individual with a disability, including a physical, sensory, psychiatric, intellectual, or other mental disability.”²

Emotional support animals are not covered by the same laws that apply specifically to service animals. ADA regulations require that all public entities and places of public accommodation provide modifications in their policies to accommodate for individuals who use service animals.³ These regulations do not provide the same protections for emotional support animals, but emotional support animals may be allowed to reside with individuals as reasonable accommodations for the individual’s disability.

Furthermore, federal regulations related to air travel require that service and emotional support animals be reasonably accommodated on all flights.⁴

Applicable Laws
Federal statutes, including the Fair Housing Act (FHA)⁵ and Section 504 of the Rehabilitation Act of 1973⁶ and the Air Carriers Access Act (ACAA)⁷, protect the rights of people with disabilities to keep emotional support animals in their homes when the landlord has a no-pets policy and to travel on airlines with their emotional support animals. These laws require landlords and homeowner’s associations to make reasonable accommodations for people with disabilities. The Department of Housing and Urban Development has stated that an exception to a no-pets policy would qualify as a reasonable accommodation.⁸

Additionally, California law also affords similar protection to people with disabilities. According to the California Fair Employment and Housing Act (FEHA), it is unlawful practice to refuse “to make reasonable accommodations in rules, policies, practices, or services when these accommodations may be necessary to afford a disabled person equal opportunity to use and enjoy a dwelling.”⁹

Disability Defined
In order to qualify for a reasonable accommodation under the FHA, Section 504, and ACAA, the individual must meet the statutory definition of “disability.” There are three broad categories of disabilities, which include: 1) a physical or mental impairment that substantially limits one or more major life activities, such as walking, working, learning, dressing, etc.; 2) a record of having such an impairment; or 3) being regarded as having such an impairment.¹⁰

California law defines a mental disability to include “any mental or psychological disorder or condition ... that limits a major life activity.”¹¹ “Major life activities” is to be broadly construed, and includes “physical, mental, and social activities and working.”¹²

Exceptions
A landlord or homeowner’s association may refuse to allow an emotional support animal if the animal poses a direct threat to others, would cause substantial physical harm to the property of others, imposes undue financial or administrative burden to the landlord, or fundamentally alters the nature of the services being provided by the landlord.¹³

Documentation
If an individual is seeking reasonable accommodation for an emotional support animal for housing, a landlord or homeowner’s association may require the individual to provide documentation of the individual’s disability and the disability-related need for the animal. The letter may be written by the individual’s primary care physician, social worker, psychiatrist, or other mental health professional and should state that the animal provides support that alleviates one or more of the identified symptoms or effects of an existing disability.¹⁴

An airline passenger who wishes to bring an emotional support animal onto a flight may be required to provide a letter that meets the following requirements:

• The letter must be less than one year old;
• States that the individual has a recognized mental-health related disability listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM IV);
• States that having the animal accompany the passenger is necessary to the passenger’s mental health or treatment;
• States that the passenger is under the professional care of a licensed mental health professional (not registered intern, associate, psychological assistant, or trainee)
• Signed by the licensed mental health professional on his or her letterhead; and
• Includes the date and type of the professional’s license and the state or jurisdiction in which the license was issued.¹⁵

Accordingly, mental health providers, including, but not limited to, licensed marriage and family therapists, licensed clinical social workers, licensed psychologists, and licensed professional clinical counselors, may write these letters on behalf of clients with disabilities seeking reasonable accommodations for their emotional support animals. The following are some issues to consider when presented with a request from a client who desires a letter seeking reasonable accommodation for an emotional support animal.

• The letter must state that the animal provides a disability-related benefit to the individual with a disability. Is it your professional opinion that the animal provides a benefit or assistance related to the individual’s disability?
• Did you prescribe an animal to help support or assist the client’s disability or was the animal incorporated in a treatment process to assist in alleviating the symptoms of the client’s disability?
• Does your treatment plan for the client include an animal to support the client’s disability?
• Have you witnessed interactions between the client and the animal or has the client discussed in length what the animal has done to support or assist the client’s disability?
• Occasionally, you may be presented with the request from a client and have no knowledge or familiarity with the client’s relationship with his or her animal and/or the client’s need for the emotional support animal. In these situations, you may not be in the best position to provide such an opinion and you may decide to deny the request. If there are other health care providers involved in the client’s care, perhaps such providers may be in a better position to provide a professional opinion and documentation about the client’s need for an emotional support animal. However, if you want to assist your client in this process, you may decide to clinically work with your client in order to adequately express a professional opinion concerning this issue. The CAMFT Code of Ethics provides that you should take care not to assess, treat, or advise individuals on problems that are beyond your level of competence as determined by your education, training and experience.¹⁶ Hence, if you incorporate an emotional support animal in your client’s treatment plan and/or choose to express a professional opinion about your client’s need for an emotional support animal, you should ensure that you are practicing within your scope of competence. Familiarizing yourself with literature and studies concerning the therapeutic benefits of emotional support animals for people with disabilities is recommended.
• The letter must also identify that the client has a mental-health disability listed in the DSM IV. While the letter does not have to provide details about the client’s diagnosis and treatment, information about the client’s disability will need to be disclosed to ensure that the client meets the definition of disability under the law. Airlines, however, are not allowed to require documentation to specify the specific type of mental health disability, e.g. panic attacks. Make sure that you obtain appropriate written authorization from your client before providing the letter. It is recommended that you discuss with your client the implications of sharing this information with third parties.
• Although unlikely, if the request for reasonable accommodation for the client’s emotional support animal is denied, the client may take legal action against the landlord, homeowner’s association, or airlines. If this should occur, it is possible that the client’s psychotherapy records may be sought by one or both parties involved in the legal matter. You may also be called to testify in this case. This means that you must be ready to answer questions about your reasoning and professional opinion on this matter.

Keep in mind that if you determine you are not competent to or comfortable with providing such a letter, you are not legally required to do so. However, you should consider the positive and negative ramifications, that writing the letter or declining to write the letter, may have on the therapeutic relationship. Understanding the relevant laws and carefully considering the clinical, legal and ethical implications can help you be better-equipped when responding to a client’s request for this form of documentation.

Resources

• Federal Housing Administration Website: portal.hud.gov/hudportal/HUD?src=/program_offices/housing/fhahistory
• US Department of Transportation/ Aviation Consumer Protection Website: http://www.dot.gov/airconsumer
• California Fair Employment and Housing Commission Website: http://www.fehc.ca.gov/

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¹Occupancy Requirements of Subsidized Multifamily Housing Programs, HUD, Glossary Rev-1 (2007)
²28 C.F.R. § 36.104
³ 28 C.F.R. § 36.302(c)(1)
⁴ 68 Fed. Reg. 24875
⁵ 42 U.S.C. §§ 3601-3631
⁶ 29 U.S.C. § 794
⁷ 49 U.S.C. § 41705;14 C.F.R. § 382
⁸ See Occupancy Requirements of Subsidized Multifamily Housing Programs, HUD, No. 4350.3, 2-44(C) (2007)
⁹ Cal. Gov. Code § 12927(c)(1), § 12955
¹⁰ 24 C.F.R. § 8.3
¹¹ Cal. Gov. Code § 12926(i)(1)
¹² Cal. Gov. Code § 12926(i)(1)(C)
¹³ Occupancy Requirements of Subsidized Multifamily Housing Programs, HUD, No. 4350.3, 2-44(C) (2007)
¹⁴ Occupancy Requirements of Subsidized Multifamily Housing Programs, HUD, No. 4350.3, 3-29(B) (2007)
¹⁵ 14 C.F.R. § 382.117(e); 68 Fed. Reg. 24875
¹⁶ CAMFT Code of Ethics Section 3.9