Emotional Support Animal 2023: Everything You Need To Know

Reviewed by Dr. Drew Sutton, MD

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Emotional Support Animal

Mental illnesses[1] are referred to as health conditions that influence the thinking, behavior, and feelings of individuals, affecting their functioning and causing distress. Mental illnesses can be severe or mild. The mental health disorders may include attention deficit hyperactivity disorder (ADHD), depression, obsessive-compulsive disorder (OCD), schizophrenia, anxiety, and other disorders.

Mental illnesses and health conditions are characterized by different signs and symptoms. The warning signs of these mental health conditions include extreme mood swings, drug or alcohol abuse, excessive anger or violent behavior, excessive anxieties, marked personality changes, prolonged depression, suicidal thoughts, and inability to cope with major life activities.

The treatment of mental illnesses involves medications and psychotherapy interventions. A useful measure to improve the signs and symptoms of mental illnesses and strengthen the ability to cope with routine activities and emerging problems is emotional support animals. This article is a practical guide to getting a legitimate emotional support animal.

What is an Emotional Support Animal?

The therapeutic benefits of animals[2] in physical health conditions are well-established. Individuals with severe visual impairments and other disabilities may derive help from individually trained service animals for therapeutic benefits including actively participating in society and functioning independently. These specific assistance animals are seen in different medical settings where the patients are sick and may derive comfort from service animals.

The individually trained assistance animals include dogs that are found in inpatient psychiatric hospitals, hospices, and pediatric wards. There is an increase in the acceptance and use of service animals in different settings with the development of animal relief areas in public spaces such as airports.

Emotional support animals are described as untrained animals used for supporting a disabled person, who is suffering from emotional or mental health disorders. With increased prevalence in the use of emotional support animals, individuals may show up on airplanes with different animals including dogs, cats, kangaroos, peacocks, pigs, turkeys, and squirrels, claiming these to be their emotional support animals.

In addition, other therapeutically used animals include service animals for mitigating the disability of an individual, disability-related assistance animals for therapeutic intent in individuals with legally recognized disabilities, therapy animals for structured animal-assisted therapy, pets for non-therapeutic companionship, and psychiatric service animals that are individually trained to perform tasks other than providing emotional support.

According to federal law, Fair Housing Act, emotional support animals are offered equal opportunity to housing despite no-pet policies. The Fair Housing Act applies to the residents who are allowed to have an animal that performs tasks, works, and assists in providing emotional support to an individual with a mental disability.

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Differences between Therapy, Emotional Support, and Service Animals

It is imperative to understand the differences between therapy animals, emotional support animals[3], and service animals before a detailed discussion about getting a legitimate emotional support animal.

Top 7 Differences

  • Service animals are allowed in public areas. Therapy animals are only allowed to access places where they are invited or welcome specifically. On the contrary, emotional support animals are allowed equal housing opportunities. The housing providers cannot impose any housing discrimination or charge animal deposit fees from the tenants. The emotional support animals are also allowed air travel according to Airline Carrier Access Act.
  • The service animals are certified by non-profit organizations including National Education for Assistance Dog Services. In contrast, emotional support animals are not formally recognized by certification processes. Instead, they require proper documentation from licensed mental health professionals. The therapy animals are registered by non-profit organizations including Pet Partners and Therapy Dogs International.
  • In terms of governing regulations and policies, the service animals are supported by the Americans with Disabilities Act. Emotional support animals are supported by the Air Carrier Access Act and Fair Housing Act. On the contrary, therapy animals are not supported by governing regulations or policies.
  • While therapy and service animals require extensive training, emotional support animals are not trained. Moreover, therapy animals receive training based on the certification program.
  • Service dogs and miniature horses are considered service animals. Therapy animals are not subjected to species restriction, however, the registration organizations may designate certain domestic animal species for therapy animals. The species of emotional support animals are dictated by local authorities, except for venomous or wildlife animals.
  • Periodic updates of documentation may be required for emotional support, service, and therapy animals.
  • The relevant authorities are legally allowed to question different aspects of service, emotional support, and therapy animals. However, the diagnosis of the owner shall not be questioned by the authorities.

Types of Pets Can Be an Emotional Support Animal

emotional support animal

Emotional support animals are companion animals that are supported by federal, state, or local laws. There is no limitation for emotional support animals. These may include dogs, cats, turkeys, hamsters, and even lizards. Before using a species as an emotional support animal, one shall obtain an emotional support animal letter and complete the required documentation with the licensed mental health professional.

Emotional Support Animal Laws

The utilization of emotional support animals is validated by anti-discrimination laws in the state and federal government. The laws require a connection between the person’s disability and the emotional support animal. The relevant laws are described as follows.

The Americans with Disabilities Act

The Americans with Disabilities Act comprises three parts corresponding to the prohibition of discrimination against animals in different settings. The law applies to general public settings including restaurants, museums, and theaters. Title II of this law encompasses state and local government agencies. Under this law, disabled individuals are permitted to access public venues and local government buildings with their service animals. The service animals only include miniature horses and miniature horses.

Moreover, under this act, the service animal behaves gently. These animals may also execute tasks for mentally disabled individuals. This law explicitly describes that animals providing well-being, companionship, comfort, or emotional support to their owners, or emotional support animals to be specific, are not qualified as emotional support animals.

The Air Carrier Access Act

The Air Carrier Access Act is undertaken by the Department of Transportation, which applies to the prohibition of discrimination against animals aboard airplanes. While the regulations under this law focus on the word ‘service animals’, this has a broader context, including the emotional support animals.

Despite offering recognition of emotional support laws, the Air Carrier Access Act allows the airlines to be precise about the regulations when dealing with these animals. Travelers with such accommodations can be demanded further information while boarding. Individuals with emotional support animals may also be required to produce a recent note by a licensed mental health professional.

Under this law, the airlines are authorized to deny the entry of certain animals that the airline may find unusual or potentially burdensome such as spiders, rodents, snakes, and other reptiles. During the previous years, the Department of Transportation has considered changing regulations about disability-related assistance animals, including emotional support animals.

Fair Housing Act

This act is applied by the Department of Housing and Urban Development and prohibits the discrimination of animals in housing. This law considers animals as reasonable accommodations for individuals with disabilities. Animals qualify for housing under the Fair Housing Act by offering emotional support to their owners that helps alleviate the identified symptoms of an individual’s disability.

Under the Fair Housing Act, housing providers are allowed to inquire about the legally recognized disability and how the disability is addressed by reasonable accommodation.

In addition to the above-mentioned laws for the utilization of emotional support animals by individuals with relevant disabilities, there are additional laws specific to these animals and other disability-related assistance animals. More than 19 states have approved the laws related to false claims of pet animals as reasonable accommodations for individuals with legally recognized disabilities.

According to the Rehabilitation Act, federal agencies are prohibited from discrimination along with other entities, which receive federal financial assistance.

How To Qualify For An Esa Letter?

In order to acquire the emotional support animal letter[4], the patients are required to undergo a thorough assessment conducted by a licensed mental health professional. One of the prerequisites for emotional support animal certification is disability determination on legal and clinical grounds. In addition to the assessment of the patient, the mental health professional may also conduct an assessment of the animal.

During this stage, the mental health professionals assess whether the animal serves effectively as an emotional support animal and ameliorates the symptoms of mental disability of an individual. This is particularly important considering that some animals are a direct threat to humans in public areas including shopping areas and during air travel. The physician also assesses whether the animal, including psychiatric service dogs or emotional support dogs, is able to cope with foreign environments.

Prior to providing an emotional support animal letter, the mental health professional also assesses the client-animal interaction to determine whether or not the presence of the animal has positive outcomes observed in the patient under concern.

How To Register An Emotional Support Animal?

Emotional support animals do not require official registration by authorities to serve their purpose. The only requirement is proper documentation and an emotional support animal letter generated by a licensed mental health professional by completing the assessment of the patient, emotional support animal, and patient-animal interaction. This letter and other important documentation are required by the housing providers and airlines.

Benefits and Risks of Emotional Support Animals

Emotional support animals do not substitute for pharmacological care and psychotherapy interventions offered by licensed mental health professionals for the treatment of mental health disorders. Emotional support animals impose health risks on their owners and other individuals exposed to these animals. The health risks include allergies, scratches, injury from bites, and zoonotic infectious diseases.

The associated adverse consequences and health risk episodes include asthmatic attacks, allergic responses during air travel, and documented injuries of the emotional support owners and other individuals. The inability to provide sufficient care to these animals and the stress of air travel may even jeopardize the welfare of emotional support animals.

Another challenge associated with getting emotional support animals is the number of patient visits required for animal documentation letters. The emotional support animal letter requires the name and birth date of the patient for verification of the patient. The emotional support animal letter also comprises the identification of a person’s disability according to the fifth edition of The Diagnostic and Statistical Manual of Mental Disorders or DSM-5.

A licensed mental health professional may discuss the challenges and barriers associated with getting emotional support from animals. For documentation required in the preparation of an emotional support animal letter, licensed mental health professionals get a chance to reassess the mental health status of the patient. This also helps in the confirmation of diagnoses, assessing the current treatment, and determining whether the emotional support animals are useful for patients.

How to Get an Emotional Support Animal?

The first step to acquiring an emotional support animal, an individual must have a legally recognized mental health disorder that is subject to thorough diagnosis and clinical assessment by a mental health professional. After obtaining a proper diagnosis, an individual can opt for any animal that provides emotional support and alleviates the effects or symptoms of mental health conditions. These animals do not require extensive training unlike service dogs and other therapeutic animals that undergo prior training.

Get An ESA Letter With CertaPet

CertaPet[5] offers emotional support letter consultation for individuals with mental health conditions who require an emotional support animal. The consultation service is compliant with state and federal laws and comprises a team of licensed mental health professionals. The process of obtaining an emotional support animal letter at CertaPet is an easy, secure, and fast one.

The three-step process begins with undergoing a free screening test to find out whether an individual qualifies for the letter. The test remains confidential and ensures the privacy of the client. The next step is consultation with a licensed mental health therapist. Depending on the state the individual is residing in, this step may take approximately 15-30 minutes. The next step is getting the emotional support animal letter by either printing it or applying for shipping of the letter to the client’s address. And voila!


Emotional support animals are important for individuals with certain mental health conditions that are legally recognized. The process of obtaining an emotional support animal letter comprises certification by a licensed mental health professional after completing client, animal, and client-animal interaction assessments.

Frequently Asked Questions

Which animals qualify as emotional support animals?

Any animal can serve as an emotional support animal as long as it ameliorates the symptoms or effects of mental health conditions in the owner.

What are the clinical assessment components conducted by a mental health professional?

The mental health professional conducts client, animal, and client-animal interaction assessments for producing a certification.

+ 5 sources

MIDSS adheres to strict procurement guidelines and relies on peer-reviewed studies, academic research institutes, and medical associations. We work mainly with peer-reviewed studies to ensure the accuracy of the information. We avoid the use of tertiary references. You can read about how we ensure the accuracy and timeliness of our content in our editorial process.

  1. Health and Study, C. (2022). Information about Mental Illness and the Brain. [online] Nih.gov. Available at: https://www.ncbi.nlm.nih.gov/books/NBK20369/ [Accessed 14 Nov. 2022].
  2. JD;Mohlenhoff, C. (2020). Laws and Ethics Related to Emotional Support Animals. The journal of the American Academy of Psychiatry and the Law, [online] 48(4). doi:10.29158/JAAPL.200047-20.
  3. Tin (2020). Emotional Support Animals: Considerations for Documentation. American family physician, [online] 101(5). Available at: https://pubmed.ncbi.nlm.nih.gov/32109028/ [Accessed 14 Nov. 2022].
  4. Younggren, J.N., Boness, C.L., Bryant, L.M. and Koocher, G.P. (2020). Emotional support animal assessments: Toward a standard and comprehensive model for mental health professionals. Professional Psychology: Research and Practice, [online] 51(2), pp.156–162. doi:10.1037/pro0000260.
  5. Certapet.com. (2020). CertaPet – CertaPet : Emotional Support Animal Experts. [online] Available at: https://secure.certapet.com/ [Accessed 14 Nov. 2022].


Rick Bayer, MD
Medical Writer & Medical Doctor
Rick is a Final Year Medical Student. Passionate about medicine, fitness and personal growth, he is always ready to challenge himself to accomplish tasks and especially spread correct medical information to people. Rick is a long-term medical writer for several sites. With more than 5 years of experience in medical writing, he has completed 200+ projects with private and business clients.


Drew is a retired ENT doctor who now lives in the Southeastern US. He was a member of the American Academy of Otolaryngology and a Fellow of the American College of Surgeons. He has a bachelor’s degree in Biology and Psychology and an MD degree. He completed his internship in General Surgery and Residency in Otolaryngology-Head and Neck Surgery and practiced for almost 30 years in all aspects of ENT, including a specialization in disorders of the ear and skull base. Drew is passionate about communicating his clinical experiences and making his knowledge more accessible to the general public by medical writing.

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