Innovations In Clinical Neuroscience

JAN-FEB 2018

A peer-reviewed, evidence-based journal for clinicians in the field of neuroscience

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R I S K M A N A G E M E N T ICNS Innovations in Clinical Neuroscience • January–February 2018 • Volume 15 • Number 1–2 50 allowing them to bring their animals to places the animals would not normally be allowed to go. This isn't just an issue of someone "getting away with something." As noted by famed dog trainer Cesar Millan, aka The Dog Whisperer, "[t]his isn't just about bothering people who might be allergic or who don't like dogs. It can be a very stressful experience for a dog that isn't trained to handle crowds or busy public places. It can also harm people with a legitimate need by forcing businesses to question everyone with a service animal." 4 Fake service dogs can also interfere with the work of true service dogs. There have been reports of actual service animals being attacked by fake service dogs and of fake service dogs biting people." Fake service dogs have become such a problem that a number of states have made it a crime to pretend a dog is a service animal. For example, Texas imposes a fine of up to $300 and 30 hours of community service work when it is found that a person "uses a service animal with a harness or leash of the type commonly used by persons with disabilities who use trained animals, in order to represent that his or her animal is a specially trained service animal when training has not in fact been provided…" 5 In California, penalties are even more stringent. "Any person who knowingly and fraudulently represents himself or herself, through verbal or written notice, to be the owner or trainer of any canine licensed as, qualified as, or identified as, a guide, signal, or service dog …shall be guilty of a misdemeanor punishable by imprisonment in the county jail not exceeding six months, by a fine not exceeding one thousand dollars ($1,000), or by both that fine and imprisonment." 6 So how do you know whether the dog your patient brings into your office is truly a service dog? The ADA permits you to ask just two questions of the dog's handler: 1. Is the animal a service animal required for a disability? 2. What work or task related to the individual's disability has the animal been trained to perform? If the handler can answer these two questions, you must give him or her the benefit of the doubt and allow the dog into the office. This does not mean, however, that you are required to let animals run loose in your practice. Service animals must be "harnessed, leashed, or tethered, unless these devices interfere with the service animal's work or the individual's disability prevents using these devices. In that case, the individual must maintain control of the animal through voice, signal, or other effective controls." 7 Also, if a dog is not housebroken or is out of control, and the handler is unable to control it, you may ask that the dog be removed. 7 Bear in mind, however, that you must still offer services to the handler without the dog present if he or she chooses to receive them. EMOTIONAL SUPPORT ANIMALS/ COMFORT ANIMALS An emotional support or comfort animal (ESA), unlike a service animal, is not trained to assist with a disability but rather its function is—as the name suggests—to provide emotional support and comfort to their owners. As the majority of questions posed to PRMS have been about dogs, they are the focus of this article; however, it's important to note that an ESA can be virtually any type of animal—dogs, cats, hamsters, lizards, even turkeys. 8 As with service animals, there is no requirement for any type of certification, registration, or specific training, and there is also great potential for fraud. "For those who wish to misrepresent their animals (either deliberately or because of a misunderstanding of its status), there are multiple entities that offer letter templates to provide as proof of ESA status, registrations as a service animal or ESA, official looking vests and harnesses, and other equipment to make an animal appear to be an assistance animal." 3 Unlike service dogs, animals whose sole function is to provide comfort or emotional support are not given rights of access under the ADA. However, both the Airline Carrier Access Act (ACAA) and the Fair Housing Act (FHA) require that reasonable accommodation be made for emotional support animals. 9 As a result, more and more patients are seeking their psychiatrist's assistance in obtaining the requisite documentation to allow them to have pets in their homes or fly with them on airplanes. Under the ACAA, if a dog (or other animal) is identified as an ESA, air carriers are required to allow the animal to accompany their handler free of charge in the cabin of an airplane. 10 However, the handler must provide appropriate documentation, which may consist of a written letter or completion of a form by a licensed mental health professional. While each airline's rules (this is from American Airlines) might vary slightly, typically they must state the following: "I am currently treating _______ for a mental health or emotional disability recognized in the Diagnostic and Statistical Manual of Mental Disorders (DSM V). The passenger needs ______ (type of animal) to travel as an emotional support or psychiatric service animal for air travel and/or for activity at his or her destination. My _______ (type of license) license was issued in the state or jurisdiction of ________ in _______ (year). Signature: ______________ Date: ___/___/____ 11 Under the FHA, service animals and emotional support animals are grouped together under the category of "assistance animals." Individuals with disabilities may request a reasonable accommodation for any assistance animal. 9 Where the individual's disability is not readily apparent or his or her disability is apparent but the need for an assistance animal is not, housing providers may ask for documentation of the need for the assistance animal to be provided from a "physician, psychiatrist, social worker, or other mental health professional that the animal provides emotional support that alleviates one of more of the identified symptoms or effects of an existing disability." 9 Those of us who are dog lovers—myself included—can appreciate a patient's desire to have his or her best friend with them, particularly in stressful situations. Anyone who's owned a dog knows that feeling of coming home after a long day and being greeted by a wagging tail. How great is that? And wouldn't it be even better if we could just take our dogs with us everywhere? Just think about how many of life's tedious and stressful situations could be improved by the presence of your dog.

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