Navigating requests for emotional support animal letters

Jennifer Middleton, MD, MPH
Posted on November 7, 2022

Countless people find companionship and support from their pets, and having their pet designated as an emotional support animal (ESA) can confer additional benefits. Many landlords do not permit pets, and finding affordable housing is currently a challenge across much of the United States. Providing patients with a letter (or a prescription) for an ESA requires that their landlord provide “reasonable accommodations” for the animal according to the U.S. Fair Housing Act. Unfortunately, some people request an ESA letter merely to circumvent landlords that prohibit pets, leading some physicians and mental health care clinicians to hesitate to provide them. Family physicians can help by following the guidelines below when patients ask about an ESA letter and also by pointing patients to resources if they are having difficulty affording their pet’s food and/or veterinary care.

The Fair Housing Act’s stipulations regarding ESAs also confer responsibility on pet owners:

At its most basic, an ESA designation means your landlord can’t charge a pet fee or enforce a breed restriction. They can’t prevent you from moving in with your animal, even if the property has a ban on pets, nor can they evict you for getting a pet. (There are a few caveats: Your pet has to be well-behaved, so it’s not destroying property or disturbing other residents.) 

As described in this 2020 AFP article, ESAs are not service animals (which are usually dogs). ESAs don’t receive any special training, and they provide benefits to their owners simply by coexisting with them. In contrast, service dogs receive specialized training to assist their owners with low vision or blindness, low hearing or deafness, other physical limitations, seizures, and certain psychiatric conditions.

Many online scams purport to offer ESA “certifications” for a (sometimes hefty) fee, but an animal can be designated an ESA in the United States only with a letter or prescription from a physician or mental health care clinician (including therapists). Although the specifics vary a bit by state, in general, reasonable diagnoses for certifying ESAs include depression, anxiety, and post-traumatic stress disorder (PTSD). According to that 2020 AFP article, if you decide that it’s reasonable to provide an ESA letter, “[t]he letter should include the patient's name and date of birth to allow verification of the owner's identity, should state that the patient has a disability recognized in the DSM-5, and should state where the emotional support animal is allowed.”

Keeping ESAs healthy benefits pets and owners, but the costs of even routine veterinary care can be prohibitive for many people. Collaborations between physicians and veterinarians are helping to bridge this gap, thanks to the One Health project. The current issue of the Annals of Family Medicine describes a “One Health Clinic for People Experiencing Homelessness and Their Animals,” where veterinary and medical doctors worked collaboratively in Seattle to provide homeless persons with “peace of mind knowing they can seek timely and quality care for their animals.” A similar initiative was described in this 2018 article, which found that a One Health clinic in California not only provided needed vet care but also connected hundreds of pet owners with medical care who had not seen a physician, in many cases, for years. As family physicians, helping our patients support their pets can pay dividends for the well-being of both.