Counseling Today, Member Insights

Is there an epidemic of emotional support animals?

By Cynthia K. Chandler February 6, 2019

On June 6, 2017, ABC News reported that a man had been severely injured on a Delta Air Lines flight after being attacked by another passenger’s emotional support dog. The dog had been sitting in its owner’s lap in a center seat. The dog reportedly growled before the attack, prompting the man to ask the owner if the dog was going to bite him. The victim received multiple bites to the face, became covered in blood, and was removed from the plane and transported to the hospital. The dog’s owner was in the military and said he had been issued the dog for emotional support.

On Oct. 29, 2017, USA Today described an incident in which a service dog, a yellow Labrador retriever, was sitting calmly in an elevator next to its owner, who was in a wheelchair. Then another woman entered the elevator carrying a toy poodle in her purse. Just as the elevator door closed, the poodle jumped out of the woman’s purse and bit the service dog on the snout, causing blood to drip on the elevator floor. After this occurred, the woman first declared that her poodle was a service dog. She then changed her story and said the poodle was an emotional support dog. Finally, she admitted the poodle was a pet that she had just wanted to bring into the building with her.

On Feb. 22, 2018, The Washington Post reported that an emotional support dog on a Southwest Airlines flight bit a 6-year old girl in the face during boarding. The flight was delayed for takeoff while paramedics examined the child and declared her healthy enough to continue with the flight. The dog and its owner were left behind.

There are important lessons we should take away from these reports, the first being that dogs bite. Or, to be more accurate, dogs without the proper temperament and training to be out in public may bite. Second, people often are not objective about their pets’ behavior and, because of this, may put other people and other dogs at risk for injury. And third, some people, such as the woman with the toy poodle on the elevator, may not be honest about their need for an emotional support animal.

Confusion around emotional support animals

The Fair Housing Act that established the right for an emotional support animal to live with its owner in pet-restricted housing does not provide any right for the pet to accompany the person anywhere else. The Air Carrier Access Act established the right for an emotional support animal to accompany its owner during air travel. As a public safety issue, it is extremely important to understand these two pieces of legislation and what an emotional support animal is exactly.

First of all, an emotional support animal is not a service animal. Therefore, rights related to emotional support animals are not covered by the Americans with Disabilities Act. Currently, there is no official oversight regarding the qualifications of a pet to be an emotional support animal. There is currently no requirement for a pet to be evaluated by a qualified animal evaluator to be called an emotional support animal. The pet’s owner is the one who decides that the pet is an emotional support animal. The Fair Housing Act regulation about emotional support animals stipulates that these animals do not have to be trained, certified or registered. It is my opinion that the absence of a requirement for proper training and evaluation of pets to be emotional support animals is a real public safety concern.

Opportunism and irresponsibility have gravitated to the realm of emotional support animals. Many services now exist, mostly in the form of websites, that charge a fee to pet owners to register their pets as emotional support animals. In reality, this type of registration means nothing because it does not signify that a particular pet possesses a temperament that makes it safe to be around, either in public or on a plane. Nor does this registration mean that the pet has any special aptitude or skill to serve in the role of an emotional support animal.

In my opinion, current commercial services that register pets as emotional support animals are mostly a scam. These services take people’s money for no legitimate purpose and mislead the public by implying that people and other animals are free from danger when around pets that are registered as emotional support animals. Presenting a pet as a registered emotional support animal is equivalent to promoting the falsehood that the pet possesses some special qualification.

Most of these website services will also sell a vest or some other type of uniform for a pet to wear in public that indicates the pet is registered as an emotional support animal. This can insinuate that the pet must be allowed in places other than the owner’s home or on an airplane (the only two places legislation actually designates that emotional support animals must be allowed). In essence, registration of a pet as an emotional support animal is worthless to everyone except the commercial enterprises that take money from the pet’s owners.

A significant lack of understanding also exists concerning the documentation required to establish a person’s need for an emotional support animal. Recently, a counselor forwarded me the official policy of a college in Florida that requires pets to be registered as emotional support animals before they can live with their owners in college housing. That policy is out of compliance with the Fair Housing Act, which does not require pets serving as emotional support animals to be registered as such. And, as a matter of course, the college’s policy is forcing people to participate in — that is, pay money for — a worthless scam known as emotional support animal registration (although the college is likely unaware of this fact). The college’s policy is further out of compliance with the Fair Housing Act because it requires health care and mental health care providers to name and describe a client’s diagnosis or disability when providing emotional support animal documentation. Naming or describing a person’s diagnosis or disability is not required by the Fair Housing Act.

The Fair Housing Act does require emotional support animal documentation to be provided by a licensed health care or mental health care provider, as well as for the recipient of the documentation to be under the care of the provider. The required documentation involves a few statements by a health care or mental health care provider, on an official prescription pad or letterhead, declaring that:

1) The person is under the provider’s care.

2) The person has a diagnosed disorder or disability. (Remember, there is no requirement to name or describe the diagnosis or disability.)

3) The person can benefit from having an emotional support animal to reduce or alleviate symptoms associated with the diagnosis or disability. (These symptoms do not need to be named or described; however, for readers’ information, common symptoms that the presence of an emotional support animal might reduce or alleviate include anxiety, depression, loneliness, and emotional or physical pain.)

Health care and mental health care providers should never specify a particular pet as an emotional support animal in supplied documentation. Why is that? One, health care and mental health care providers are unlikely to be qualified to evaluate animal behavior. And two, they would basically be endorsing that particular pet as an emotional support animal, thereby placing themselves at jeopardy for a lawsuit should the pet injure someone. By the way, the flawed college policy I mentioned earlier also erroneously required health care and mental health care providers to describe in their documentation the specific emotional support animal and its abilities. Once again, this is not in compliance with the Fair Housing Act.

Documenting need

Another major public safety issue is the documentation that health care and mental health care providers are now supplying to support the seemingly epidemic need for emotional support animals. Over the past few years, I have found that a large number of mental health care providers, including many licensed counselors, are playing loose with the ethics of the duty of care in the way they are providing this documentation.

Allow me to outline three questionable activities I have observed or learned about that give me cause for concern.

  • Some mental health care providers supply documentation of a person’s need for an emotional support animal after only a single visit and then exercise little or no follow-up. Thus, the client’s need is not thoroughly assessed or properly monitored.

Technically, a person may be considered to be “under the care” of a mental health care provider after only one visit, but in my opinion, a single visit for the sole purpose of providing emotional support animal documentation is a gross misrepresentation of the duty of care. Also, I recommend that mental health care providers place a termination date of six months on the supplied documentation because a person’s condition can change and, thus, so can the need for an emotional support animal.

  • When supplying documentation, some mental health care providers do not assess or consider the client’s ability to determine whether a pet (emotional support animal) might be a disturbance, a danger or destructive.

Providers of emotional support animal documentation need to consider their obligation to public safety — that is, their role in helping to protect those with whom a client with an emotional support animal may come into contact. Remember, an emotional support animal is any pet that an owner wants to declare as such. It is unlikely that the designated emotional support animal will have training or have been evaluated for proper temperament.

  • Some mental health care providers supply documentation endorsing the need for an emotional support animal to people with whom they have had little to no direct contact.

Consider this scenario: A new for-profit enterprise is growing by leaps and bounds. This enterprise involves website services that document individuals’ needs for emotional support animals. These internet services are recruiting large numbers of mental health care providers, especially licensed counselors, to join a network to review questionnaires completed by applicants requesting documentation of their need for an emotional support animal. On the basis of the questionnaire, and sometimes a brief communication with the applicant via telephone, email or webcam, the mental health care provider assesses the applicant, provides a diagnosis and determines that the applicant could benefit from having an emotional support animal. On the basis of the mental health care provider’s brief assessment and applied diagnosis, the website service then provides a form letter to the applicant after taking a fee.

Several counselors have contacted me asking whether they should accept the invitation they received to become a provider for this type of web-based service that supplies emotional support animal documentation. I always recommend that they decline such offers. I do not consider these types of services ethical or responsible. Furthermore, I believe any mental health care provider who works for this type of service to provide emotional support animal documentation in this accelerated and impersonal manner is:

1) Performing at a highly questionable level of ethical functioning regarding duty of care

2) Contributing to the potential endangerment of those who may come into contact with emotional support animals that do not have the proper temperament and training to be out in public

3) Contributing to an epidemic of emotional support animals

An escalating problem

The large and growing number of emotional support animals is highly problematic. The public often confuses emotional support animals with working service animals. Unfortunately, because of this, people have learned that they can get away with taking their emotional support animals just about anywhere, even though they have no legal right to do so.

This confusion often occurs because:

  • Federal law does not require that a service animal wear a uniform or have documentation.
  • People often do not want to offend a person who may be accompanied by a service animal, so they do not inquire if the animal is truly a service animal.
  • The law places a limit on what a person accompanied by a service animal can be asked. Only two questions regarding a service animal are allowed: Is the animal required because of a disability? What work or task has the animal been trained to perform? Specific questions about the person’s disability are not allowed.

Because of the general public’s confusion concerning service animals versus emotional support animals, people with emotional support animals can easily misrepresent themselves as being accompanied by a service animal and go places where they are not allowed. Falsely claiming that a pet, including an emotional support animal, is a service dog is illegal in some states. According to a 2018 article in Texas Monthly, such a false claim made in Texas is classified as a misdemeanor and is subject to a fine of up to $300 and community service at a place that serves people with disabilities.

There is no way to determine how many emotional support animals there are, but it is clear they are rapidly growing in number. A 2014 article in The New Yorker detailed one commercial website that registers pets as emotional support animals. It reported 2,400 such registrations in 2011; the number at just that one site grew to 11,000 in 2013. So, yes, we have a growing epidemic of emotional support animals.

Lack of official oversight regarding the behavior of emotional support animals, along with the poor judgment of some owners, is resulting in public nuisances and endangering public safety. It has been demonstrated that people want to take their pets places that pets should not go. Furthermore, the public’s confusion about rights of access for service animals versus emotional support animals is adding to the problem. In addition, many health care and mental health care providers are contributing to the epidemic numbers of emotional support animals by their irresponsible, and perhaps unethical, approach to providing documentation.

Significant efforts need to be made to address the problems caused by the epidemic numbers of emotional support animals. USA Today reported that several states are cracking down on individuals who falsely claim to have service dogs just so they can take their pets or emotional support animals anywhere they please. Mental health care providers can certainly assist by being more responsible in their provision of documentation for emotional support animals. This can be accomplished by:

1) Providing proper and thorough assessment of a client’s need for an emotional support animal

2) Placing a time limit on the validity of the documentation they supply

3) Requiring follow-up visits from clients to renew documentation for emotional support animals

Mental health care providers can also decline to associate themselves with commercial web services that provide emotional support animal registries and documentation, because these services are designed to attract as many customers as they can, as fast as they can, for as much profit as they can.

In concluding this article, I want to clarify that I am very much in favor of emotional support animals living with their owners in housing. However, until federal or state governments pass legislation requiring greater oversight for emotional support animals, especially related to animal behavior requirements, and until many suppliers of emotional support animal documentation act more responsibly, we are all going to be at risk for being bitten, especially on an airplane. For now, our welfare is in the hands of the owners of emotional support animals.




For more information, refer to the following resources:




Cynthia K. Chandler is a licensed professional counselor and a licensed marriage and family therapist in Texas. She is a professor in the Department of Counseling and Higher Education at the University of North Texas and director of the university’s Consortium for Animal Assisted Therapy. Contact her at


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  1. Andrea Harris

    The concept of emotional support animal has certainly picked up steam. With more and more people misusing the noble idea, the people who actually need the emotional support animal are suffering.
    I am saying this from the point of view of an esa owner. I got my terrier and my life couldn’t have been better. He is just the love and care i needed in life. But the people who are misusing it is causing people like me a lot of trouble. People now see us like we are faking it.

  2. Paul

    This a very well written article that gives information and guidelines on providing documentation for ESA. It would be very beneficial for the ACA to develop a “white paper” on guidelines for writing ESA documentation and for colleges and universities accepting ESA.

  3. René Garrett

    This is the best article on ESAs that I have read! I just wish I had read it first. I am researching ESAs on College Campuses. This is a hot button topic in higher education. The Fair Housing ACT applies to college dorms so, the ESA issue is on the increase in our nation’s colleges and universities.

    1. Dr. Psych Lady

      Students that reside in any college dorm in any University are to be extended their request for a reasonable accommodation for housing. That means that as long as that student presents specific documentation, or an ESA letter written by their mental health provider to the respective disability services coordinator, and the documentation is from a LMHP that diagnosed the student with a mental health condition, e.g and/or mental health/emotional disability, there should not be a problem with approving that reasonable accommodation. Now, there are some universities that will push back because they will state that the provider is “not reliable”, however, how are they defining those parameters? That is another rather complex problems because of imprudent information circulating on these the internet that is inaccurate and invalid set out to disqualify valid and very qualified providers without even confirming their information. Any University must give that student a chance to have his/her LMHP verify the diagnosed disability through a reasonable accommodation.

  4. K Livsey

    Thank you for this article. I have been trying to research this challenge as it pertains to rules in a homeless shelter. It has been hard to accommodate and determine true need based on crisis stabilization services. It has also been difficult to meet housing requirements and maintain the safety of other clients with the increase of animals arriving with their owners.

  5. Christine Boudreau

    I am interested in learning more about the author’s opinion of a timeline of six months to reassess the need for the ESA. Is the author advocating that once the patient’s symptoms have improved, the patient should then get rid of their animal? Or is she saying that after they are improved, the provider who wrote their ESA letter should simply rescind it – likely resulting in the patient’s need to move out of the apartment which required the letter in the first place?

    1. Cynthia Chandler

      An ESA is a person’s pet regardless of whether an ESA letter expires or not. They do not have to get rid of the pet. Though they may have to move to different housing. The emotional/mental health need to have a pet serve as an ESA can change, and thus so can the need for an ESA, thus a letter needs to have a time limit on it to require follow-up assessment and care. Follow-up assessment and care is part of proper duty of care for a client. Federal law states that a person must have a valid ESA letter, otherwise they cannot receive the benefits of having a pet in pet-restricted housing or have the pet fly free on an airline. But they sitll have their pet.

  6. L W

    I would suggest researching with respect to the human animal bond and the “significance” of emotional support animals. Research has proven time and time again, with a recent study from Mayo Clinic, the benefits of emotional support animals. This is not saying people should misuse the program – but those who have doctors or medical provider letters are warranted to have their ESA living with them. Housing communities can and have had suits initiated against them for violations of the FAIR HOUSING ACT. Folks who truly need ESAs are truly suffering without their medically needed animal. As a final note people SHOULD NOT APPROACH or PET any animal without the owners/handerl’s permission….Period. And parents should educate their children not to antagonize, tease or traumatize animals that can lead to bites – the cause being the children or adults provoking the animal.

    1. Mantis Toboggan

      How is it the person’s fault when they are sitting next to a dog on a plane and they get bit? I’m fine with emotional service dogs, but if they bite someone you should be liable for a serious lawsuit.

  7. L

    As a landlord, I challenged a tenant who was keeping a dog (against the no-pets rule in the lease.) The next day, the tenant went to her local therapist (an M.D.) who wrote a one-sentence letter on employer letterhead, “This is to certify that Firstname Lastname has a dog for emotional support.” Query: Does this meet the required documentation under the FHA as described in the article? Very likely not. My call to the therapist revealed that he knew nothing about ESA rules, and wrote the letter as an accommodation at the tenant’s request. Query: If I would deny the animal and evict for violating the no-pets rule, could the tenant succeed in filing an FHA Complaint? Very likely so. Mental health care providers need far more education on this topic than they are getting. They are creating abusive and problematic situations for property owners.

  8. Dr. Psych Lady

    First of all, it is housing providers that NEED education when it comes to persons diagnosed with a valid disability.
    Moreover, who are you to challenge a MD or licensed psychologists authority or scope of competency? Clearly, you are have no understanding of what it requires for a person to be diagnosed with a valid mental health condition, or what that means for symptoms to be ongoing. Let me define that for you under current ADA and HUD laws: Eligibility for Services
    Students must show evidence of their status as a person with a disability as defined by the Americans with Disabilities Act of 1990 (ADA), and its Amendment Act of 2008, and Section 504 of the Rehabilitation Act of 1973, and its revision of 1974.

    Under those laws, a person has a disability if they have “a physical or mental impairment that substantially limits one or more major life activities (e.g., walking, standing, seeing, speaking, hearing, breathing, learning, working, or taking care of oneself), has a record of such an impairment, or is regarded as having such an impairment.”

    A “qualified person with a disability” is defined as one… “who meets the academic and technical standards as requisite to admission or participation in the educational program or activity.”
    Licensed mental health professionals diagnose for purposes of patients meeting DSM-5 and ADA/FHA Air Craft Carrier laws criteria. It is not for a letter, that is ancillary. Hence, because [landlords/housing providers] are not mental health professionals, you are the ones out for the pet deposits could most likely care less about your tenants mental health care needs.

  9. L W

    Agree with Dr. Psych Lady in that landlords/housing providers NEED TO BE EDUCATED. It is not for them to even think of making a medical diagnosis nor should the landlord/housing provider be privy the renter’s actual medical issue. Almost every valid animal organization (including the AVMA, ASPCA, HABRI, etc.) have documented research/studies emotional support animals are very, very important to the health and well being of people from all walks of life. Many housing communities have recognized or are in the process of recognizing non pet discrimination in any form or shape (breed, size, weight,etc). Insurance companies are also on board by not discriminating against pets (cats, dogs primarily). To do otherwise further stigmatizes someone with a medical problem that is substantially alleviated by having an emotional support animal. Furthermore, not every medical illness or disease is evident. The loss of an emotional support animal because of some landlords backward thought process can and does cause irreparable medical harm. I will reiterate what Dr. Psych Lady has already stated, {landlords/housing providers] are not mental health professionals and, I will add, neither are their legal counsel who (sometimes) encourage discrimination against emotional support animals.

  10. JP

    My daughter is severelly allergic to cats. The University she attends approved an ESA cat on her dorm floor without notice to the other students. My daughter has been wheezing and coughing since November 9, 2019; had to seek urgent medical treatment. The student with the ESA continuously violates the contract by taking the cat to the common areas of the dorm hall. The University does not have policy which stipulates consequences if the contract is violated. The University wants my daughter to move although there are multiple students on the dorm floor who are allergic to cats. Please provide advice on how to resolve this matter.

  11. F

    What about the possibility of a person with a diagnosed mental health condition who has never declared their pet an ESA (nor received or issued documentation) until it becomes apparent that they are unable to care for the animal, and as a result have been issued a warning by their landlord that improper care will result in a revocation of pet privileges in the dwelling? How do we both support pet ownership for a person in need of an ESA while also preventing the neglect of that animal by a person incapable of caring for the animal? People living with mental illness should not be stigmatized, but ESA ownership should also be mutual, no? There are still laws against animal cruelty, abuse, and neglect whether or not a person has received documentation of their need for an ESA or has simply declared it verbally once in danger of being reported for cruelty. What is more important: a person retaining ownership of an animal they cannot properly care for because they need the emotional support it provides, or an animal being guaranteed a safe and healthy environment with a capable caretaker? Do we run the risk of discriminating against mentally disabled individuals by having their animals taken away for improper care or is the issue cut and dry—abuse and neglect and cruelty will not be tolerated under any circumstances?

  12. Ford

    Well written article, I don’t agree with all of the points you made but I objectively understand your stance and why you’ve chosen it. I think a big part of the issue stems from pet and specifically dog breed discrimination. I think it’s fair to say that a lot of people have mental health issues that they are not regularly seeing a healthcare provider for. Their dog might already be a go-to source to alleviate their symptoms but they are forced to have a doctor’s letter in order to prove that. I don’t think it is fair for a well tempered and controlled pet to be subjected to breed specific legislation (BSL) which in turn leaves owners with the choice of either having their loved one adopted or not finding a place to live… Shelter is a basic human need and until you have a pet that is discriminated against due to their breed, you can’t fully grasp the housing crisis these people are going through. You describe a pandemic of emotional support animals and I think BSL is one of the major root causes. I don’t feel that an emotional support animal should be allowed on a plane without temperament screening and generally people don’t need to be on a plane in order to survive. People DO need fair housing to survive and in that regard I am more okay with online services that provide ESA letters than I am with laws that prevent people from having a pet and receiving emotional support from that pet. If a landlord lists a property as pet-friendly then they should be obligated to A.) screen the pet before accepting tenancy and B.) Not be discriminatory to entire breeds or mixes of those breeds.

  13. Ana

    If you are writing about ESA then it should be about that. Not some fool who took a dog into her purse who then attacked a legitimate ESA. Putting stories out there like this could negatively influence things where ESA would be prohibited where people need them. I have one but I muzzle her because she would bite strangers and other animals. She is kept home. It’s the dog not the person who needs training on how to control them.


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