Do Emotional Support Animals Actually Help?

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Recently, the panelists on a popular Fox News daytime talk show, "Outnumbered," got in a spat about the presence of support animals on college and university campuses. Co-host Emily Compagno, for example, exclaimed, “I don't think these kids need cats; I think they need a slap in the face!”

I disagree.

But the Fox News brouhaha inspired me to examine the evidence for the use of emotional support animals in the treatment of mental disorders.

Nearly every pet owner will tell you their companion animal provides them with emotional support. My cat Tilly often helped me get through the day. In the United States, however, the term Emotional Support Animal (ESA) confers legal status that does not apply to other pets. The term refers to animals that help individuals suffering from a diagnosed psychiatric disorder. ESAs are covered under several sets of federal regulations, including the Air Carrier Access Act and the Fair Housing Act. (Note: The term “service animal” is a different legal category that allows specially-trained assistance dogs access to public spaces such as restaurants and museums as well as aircraft.)

The Fair Housing Act prohibits discrimination against people with disabilities in rental housing. The law allows tenants with diagnosed psychiatric disorders to live with emotional support animals in no-pet properties such as apartments and college dorms.

Here is how the Act pertains to emotional support animals:

• Unlike service dogs, ESAs can be members of any species, though special regulations may apply to non-traditional pets.
• Unlike service dogs, ESAs are not required to be trained to perform specific tasks.
• Unlike service dogs, pets can be considered ESAs.
• While the law allows ESAs to live with their owners in no-pet housing, it does not give the animals access to public places such as stores, train stations, or college classrooms and cafeterias.
• The owner of an ESA must suffer from a recognized mental disability—for example, PTSD, depression, autism, or an anxiety disorder.
• ESA owners must submit to landlords and universities a letter from a health professional stating the owner has a disability that limits their ability to function and that their animal helps them to cope with daily life challenges.

Are Emotional Support Animals Effective?

Laws allowing emotional support animals to live in no-pet housing, including dorms, are based on the supposition that researchers have demonstrated the effectiveness of ESAs as treatments for mental disorders. Hundreds of research papers have been published in scientific journals on the impact of psychiatric service dogs and therapy animals on mental health and well-being. But is this also true of emotional support animals?

I recently conducted an extensive search for published studies assessing the effectiveness of ESAs. To my surprise, I found only one. It was a 2022 longitudinal pilot study conducted by Janet Hoy-Gerlach of the University of Toledo Social Work Program and her colleagues. As the authors correctly claim, theirs was the first study on the effectiveness of emotional support animals to be published in a peer-reviewed journal.

The ESA Study

Through an ESA placement program, the researchers gave shelter dogs and cats to adults suffering from severe mental health issues. Before they got their support animal, the patients completed standardized psychological measures of anxiety, depression, and loneliness. They were tested again a year later.

The subjects: The subjects were 11 individuals with serious mental health issues. Six adopted an ESA cat and five adopted an ESA dog.

The results: After a year of living with their ESAs, as a group, the participants had considerably improved anxiety, depression, and loneliness scores. These results are encouraging. But, as the researchers pointed out, there were limitations to the study that prevent general conclusions about the benefits of ESAs.

The limitations:

• This was an exploratory pilot study with only 11 participants.
• The patients were diagnosed with a grab bag of psychiatric problems including major depression, PTSD, bipolar disorder, and schizoaffective disorder.
• Most importantly, the study did not include a no-treatment control group. As the researchers noted, the lack of a control group means we cannot conclude that the emotional support animals were responsible for improvements in the mental health of the participants. The results could have been due to factors unrelated to the presence of the dogs and cats. For example, during their year with the ESAs, the patients also continued to receive traditional mental health treatments. Thus, remission of their symptoms could have been due to ongoing psychotherapy or medications they were taking. Further, studies have shown that about half of the people who suffer from major depression show significant improvements over 12 months with no treatment at all. So, these results could simply reflect spontaneous recovery. Despite these limitations, the research received considerable media attention. One headline, for example, proclaimed "Emotional Support Animals Have Proven Benefits for Those With Mental Illness".)

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The study is important because it is the first attempt to measure the impact of emotional support animals in real-world settings. And it demonstrated the feasibility of conducting more rigorous longitudinal investigations of ESAs. But because of the limitations, it did not show that emotional support animals have "proven benefits" for people suffering from mental illnesses.

Are Emotional Support Laws Built on a House of Cards?

In the Animal Law Review, attorney Tara Waterlander noted that Congress enacted legislation giving emotional support animals access to housing and free air travel based on the supposition that there is “substantial and medical evidence that emotional support animals are effective forms of treatment for various disabilities.”

Yet, this is not the case. In reality, there is little or no empirical evidence demonstrating that air travel with, or living with, emotional support animals ameliorates psychological disorders. Indeed, both regulatory agencies and mental health organizations are having reservations about the use of emotional support animals. The lack of evidence that ESAs are needed for air travel, as well as the fake-ESA letter problem, prompted the Department of Transportation in 2021 to change the rules pertaining to emotional support animals. As a result, no American-based airlines now allow ESAs on their planes.

The American Psychiatric Association is also skeptical of the efficacy of emotional support animals. In a 2022 report, it concluded: “Given the limited evidence supporting ESAs, it is ethically permissible (for mental health professionals) to decline to write ESA certification letters for patients.”

In short, there are a lot of reasons to have a pet in your life. But as of yet, there is no convincing evidence that emotional support animals are necessary for people with mental disorders to board an airplane or live in a college dorm.

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