Savannah Lee with her emotional support dog Veda at Flat Run Veterans Park on Wednesday, March 17. Lee utilizes Veda as her Emotional Support Animal to help her combat anxiety and depression. Photo by Haley Parnell
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Emotional Support Animals Under Scrutiny

Workers in the service animal industry question the legitimacy of increasingly popular emotional support animals (ESA)

At the University of Cincinnati’s Medical Center, the Director of Auxiliary, Volunteers, and Interpreting Services Sheila Maxwell, talks to a Type 1 diabetic patient with a service dog. The patient’s blood sugar levels start to drop, and the service dog takes its nose under its owner’s arm and starts flipping it and flipping it, trying to alert them to take their insulin. After 15 minutes pass by, the dog begins to growl. The owner tries to calm the dog down and assure it that they know what they’re doing. Another 15 minutes pass, and the dog beings to bark at its owner until they physically show the dog they are taking their insulin, and the dog settles back into position.

Maxwell is one of many people in the service animal industry who want people to educate themselves on the differences between ESAs and service animals– specifically service dogs and why ESAs can be harmful to the service animal industry. There are many dissimilarities between service animals and ESAs, and people are not afraid to express their thoughts and feelings on the lines that people can cross with their pets. The distaste comes from the lack of training required, such as the two-year minimum requirement for service dogs versus the no training needed for an ESA. A system that lacks rules for ESA ownership, making it all too easy to find loopholes and abuse the system. And the insufficient differences between a household pet and an ESA. As the popularity of ESA ownership continues to become more popular, it is crucial to recognize why these animals pose a threat to the service animal industry.

Training makes the difference

One of the most important things to keep in mind in understanding the differences between the two is that an ESA is not a service animal. Kelly Camm, development director for 4 Paws for Ability, Inc. (a nonprofit organization that places service dogs with children with disabilities) emphasizes how important the correct terminology is. “A service dog is trained [in a specific area of expertise] to help a person with disabilities. A therapy dog is someone’s pet that they get trained to visit sick people, whether it’s a nursing home or a hospital. And an emotional support animal is generally your pet trained or not,” she says.

UC Health’s official pet therapy vest approved for the University of Cincinnati Medical Center [UCMC]. Photo provided by Sheila Maxwell.

Certified tester for the Pet Therapy Program at UC Medical Center Sandy Kordis-Rubin has been testing people’s pets to become therapy dogs since the 1980s. “I can now almost feel a dog’s sense when they turn the corner and walk in and look at me,” says Kordis-Rubin. “I’ve just been doing it so long; you get a sixth sense about it.”

The testing process Kordis-Rubin explains looks at the dog’s behavior with other dogs and people, their temperament and their heart for understanding people’s emotions in the hospital environment. “They have to learn to read people’s emotions; they’re not born that way. They have to understand this is a job,” says Kordis-Rubin.

People who need an ESA view them as more than just their pets. A graduate candidate of health administration for the University of Kentucky, Savannah Lee, originally got her Golden Doodle Veda without the intent to register her as an ESA. She planned and saved for a dog once she moved into her apartment, liking the idea of the added protection Veda could provide to her as a young woman living alone. However, living alone can be lonely enough, and living alone during a year where everyone was stuck inside brought on mental health issues for Lee in July of 2020. Then, with a bad breakup in October weighing heavily on her, Veda became more than just a companion for Lee.

Savannah Lee at Flat Run Veterans Park on Wednesday, March 17. Lee visits the park to walk and play with her dog Veda. Photo by Haley Parnell.

“I talked to my psychiatrist and my therapist, and they both signed off on it. And that’s how I got her [Veda] to be registered,” Lee says. “And then there was something online that I had to fill out, and that’s how I got her housing agreement and her travel agreement. I had to go through my therapist and my psychiatrists for a certificate of proof that I needed help or needed a dog.”

Savannah Lee walks her emotional support dog Veda at Flat Run Veterans Park on Wednesday, March 17. Veda obeys Lee as she tells her to stop mid-walk. Photo by Haley Parnell.

Kordis-Rubin says that the proper way of going about getting a dog for a psychiatric disorder is having a psychiatrist sign a letter stating that you have a psychiatric disorder and need a dog; however, this is not called an ESA it is called a psychiatric service dog. Kordis-Rubin says, “there is no such thing as an Emotional Support Dog.”

Service dogs and pet therapy dogs go through training to provide a service. Maxwell says, “The training for a service animal is at least two years, if not longer. A lot of times, for diabetic and epileptic patients, there’s at least a six-to-eight-month training that occurs between the patient and the dog. So, that they really understand what that patient needs, and how to perform the task.”

There is no place for emotional support animals anywhere because they’re always somebody’s pet and, we need to treat them like somebody’s pet.

Sheila Maxwell

The way Maxwell puts it, is a service animal is “very well trained, and they’re not trained as pets. They’re trained for service, and it is extensive,” she says. Maxwell emphasizes that service dogs are brought in busy places like restaurants, businesses, or on a walk by a busy street to get used to people and noises. She points out a pet’s value and how it becomes part of the family, taking on an emotional support animal’s role naturally. In contrast, the value of a service animal goes beyond that companionship.

Sheila Maxwell with UC Health’s pet therapy dog Gracie, preparing to get on their pet therapy float at the Red’s Opening Day Parade in 2019. Photo provided by Sheila Maxwell.

Animals tend to freak out when put in an environment that they are not used to. Specifically, for Maxwell working in a hospital, it can be detrimental for the dog when people sneak them in or try to pass them off as a service animal. Dogs are put in purses or paper bags to be brought in unnoticed. There have been instances where those animals freak out and begin to bark and squirm. Some have even bit the healthcare workers or their owners out of fear.

“Hospital environments are the biggest risk,” Maxwell says. “When you walk into a hospital, they can smell the cleaning disinfectant; they can smell medication. Animals are super sensitive. They can smell if you have diabetes, some can smell if you have cancer, some can detect epilepsy. They’re hypersensitive, and some smells make those ‘quote unquote’ family pet’s minds start to question what is going on. Why am I here? What is my purpose? And then it’s kind of like a fight or flight deal.”

Pet therapy volunteers working an event in 2019 with the pet therapy dogs at the University of Cincinnati Medical Center [UCMC.] Photo provided by Sheila Maxwell.

The first day of training for pet therapy dogs in the hospital is a walk-through just so the dogs can take in all of the new smells. Dogs have to adapt to highly stressful environments because of how hypersensitive they are. Kordis-Rubin says, “They [the dogs] will absorb pain and emotion. And if they don’t know what to do with it, they can get PTSD.”

Although no proper training is required to register an ESA, both Maxwell and Camm agree that there are places to take your animal to get them trained so they can behave appropriately in public. “They could take them to do basic obedience at PetSmart or other training facilities. Just so that they have good manners,” Camm says.

Whether your dog is an ESA or not, it is common courtesy towards other pet owners to put your dog in an obedience school. “At the same time, you’re socializing that animal to other people and other animals,” Maxwell says. “Nothing is worse than going to a dog park and having dogs go jump on other dogs, bully dogs or get into a fight.”

Because Lee got Veda during the COVID-19 pandemic, she says she has not been able to register her for any professional training courses but plans to when businesses are more open.

The problem with ESAs being passed off as service animals are that they can have behavioral issues that reflect poorly on trained animals providing a service. Some ESAs aren’t trained and, therefore, don’t know how to behave properly in public.” Camm says, “If they have this big service dog vest on, then someone sees that dog acting up barking at other dogs or pooping somewhere, eating food off the person’s plate or whatever it is. Then it becomes a bad name to those of us that train service dogs because then that person has in their head, ‘Oh, that’s a service dog.’”

Taking Advantage

The people who are taking advantage of the ESA system are the ones giving them a bad reputation. There are many ways to get around rules if you have a registered ESA. Things like the Fair Housing Act allow you to have an animal in residences like an apartment that doesn’t allow animals. According to HeinOnline[a law journal library], “If an individual’s mental disability could be mitigated by owning an animal, a doctor may recommend an emotional support animal. Because these animals are meant to serve medical purposes and are not merely pets, they qualify under the ‘reasonable accommodations’ provisions of the Act.” Regardless if they need the animal for a mental illness, people abuse the Act so their pets can live with them.

In the past, a registered ESA also meant bringing your animal on a flight for free. However, those laws are now changing. Before the Department of Transportation changed flight rules in January of 2021 to regulate flying with an ESA, people were using ESA laws as an excuse to bring their animals on flights for free.

Not only were people bringing dogs in airports and on planes with little training, but they were also bringing cats, turtles and, in one case, a peacock. People were abusing the system, but they also took advantage of ESAs being any animal, not just dogs, further adding to questioning an ESA’s legitimacy.

All major airlines such as Delta, American, United, Alaska, Allegiant and Southwest have now banned ESAs from flights. Delta’s website states, “In accordance with the final rule from the U.S. Department of Transportation [DOT], Delta will no longer recognize emotional support animals as service animals beginning January 11, 2021.” Airlines will allow you to pay for an animal to bring them on a flight, but they must meet specific size standards and fit in a carrier under your seat. Those major airlines are also only accepting dogs on flights; however, that excludes Spirit Airlines, which, according to their website, allows domestic cats, small household birds and small domestic rabbits on the aircraft.

Flights can be triggering for animals just like a hospital atmosphere can be. Camm says, “It’s dangerous if that dog is aggressive to other dogs or possessive of other dogs or doesn’t know how to handle being on an airplane. All the vibrations and the barometric pressure change, it could get aggressive or agitated and then do some harm kind of fight or flight response.”

In December of 2020, before the DOT changed flight rules regarding ESAs, Lee brought Veda on a flight from Kentucky to Arizona Lee gave Veda a CBD-infused treat to ensure Veda would behave on the airplane and to keep her calm. She says, “The flight was perfect. She slept the entire time.”

Savannah Lee’s emotional support dog Veda wears her emotional support vest as she sleeps on the plane ride to Arizona in December 2020. Photo provided by Savannah Lee.

Lee did feel like she was receiving extra attention from people around her because she had a dog. “I got a ton of looks when I was in the airport because she is a puppy. She jumps and wants attention. She’s not fully trained either. So, of course, I did get many looks in the airport, either because she’s cute or because she has an emotional support vest on,” Lee says. “That means either I’m being stereotyped using it as an advantage, so I don’t have to pay for her flight ticket, or like everyone knew I had mental health issues if my dog was wearing this vest.”

Many websites are marketed towards people with ESAs, but they are not the proper way of registering your animals. “It is a very easy thing to do online, and that’s why people abuse it,” Lee says. There are sites you can go on and pay $100 to get paperwork that states you need your ESA to fly. Lee admits to falling for one of those sites thinking it was a good idea at the time, but after receiving the paperwork and realizing it didn’t seem legitimate, she went a different route. “The [American] airline did make me give them a paper of our airline travel allowance, and my doctor and my vet had both signed something from the airline,” Lee says. “I had to have the paper that shows she was an emotional support dog. Then I had a paper from my therapist, that she [Veda] was there to support me and one from the vet that she was healthy and had all her shots.” Lee says there is no way people could buy the $100 certificate online and use it to get on the airplane with their pet due to all the required paperwork she had to fill out.

Maxwell agrees that these sites take advantage of people and a system that lacks regulations. “I hate to say it, but somebody is making a lot of money on these emotional support dogs because you can go online, and you can get a certificate from somebody you’ve never met and pay them $350, or whatever their price is. And it’s not right,” she says. Aside from the illegitimate ESA registration websites, sites like Amazon have made it easier than ever to acquire fake service dog vests that can be used to get a pet into a business or hospital that would otherwise deny their entry.

“People were taking it too far. So they had to crack down, and some airlines won’t permit them [ESAs] anymore. So, we’re happy about that, but at the same time, it’s still going to cause more people to buy a fake vest,” Camm says.

The changing of laws and more restrictions placed on ESA ownership is a step in the right direction for people in the service dog industry; however, Lee says these new rules are regressive for people with mental health issues. “It’s the 21st century we’re trying to normalize behavioral health. We’re trying to normalize mental health,” Lee says. “Then the airlines go ahead and do this [enforce restricting laws for ESAs]. It’s counterintuitive. Take one step forward, two steps back kind of thing.” She says there shouldn’t be a “this or that” mindset for needing a dog for a physical disability or a mental one, and airlines should honor dogs who support people with mental health issues.

I’m hoping the more normalized mental health and behavioral health will be, the more common and accepting emotional support animals will be

Savannah Lee

Is there a need for ESAs?

“There is no place for emotional support animals anywhere because they’re always somebody’s pet and, we need to treat them like somebody’s pet,” Maxwell says.

Savannah Lee plays with her emotional support dog Veda at Flat Run Veterans Park on Wednesday, March 17. Veda follows Lee around everywhere and loves being played with. Photo by Haley Parnell.

ESAs are an extremely touchy subject to people who work with service dogs. People trying to pass off their pet as a service dog and the lack of education between knowing the differences between service dogs and ESAs, Camm says, is the issue. “You are only allowed to ask someone that walks in with a dog, ‘what are the tasks that the dog is trained to do,’” she says. The lack of questioning prevents most businesses from turning away animals. While it is an overall consensus among the service animal industry that ESA ownership should require more regulations, many people rely on them for comfort.

Not only does Kordis-Rubin have years of experience training pet therapy dogs, but she also has a service dog-Emma-that provides her help with her mobility. As a service dog owner, Kordis-Rubin says, “I’m more on an army to stop it [ESA ownership] than before.” She says if someone is emotionally unstable, they should have a psychiatrist and shouldn’t mind asking them for a letter that would, in turn, make their dog a legitimate service dog as opposed to an ESA.

There have been studies conducted to show how ESAs help people with depression and anxiety. According to the Journal of Medical Ethics, “In an interview-based survey, 70% of ESA users report their ESAs as having a calming effect, 40% of handlers report their ESAs helping them focus on the present moment enough to perform necessary tasks and 20% report needing their ESA to perform basic tasks. All handlers of ESAs reported a close connection to the animal.” Based upon these results, the Journal of Medical Ethics says mental health professionals agree that “ESAs are extremely beneficial for people with mental illnesses.”

Savannah Lee with her emotional support dog Veda at Flat Run Veterans Park on Wednesday, March 17. Lee stops mid-walk with Veda to give her pets and kisses. Photo by Haley Parnell.

Within the past year, Lee has been diagnosed with depression and anxiety disorder. “I went through a lot of episodes of depression in December and January, and I do not think I would have been able to get through it without her. I went through a breakup in October, and that was hard; breakups are always hard,” Lee says.

Lee sits on a couch in her living room, tossing a ball for Veda to fetch. She says, “she reminded me to eat when I fed her. I was forced to take her outside to go to the bathroom. So, I was forced to get out of bed; I was forced to put shoes on; I was forced to get fresh air. She helped me in all of those physical ways. Like right now, she’s forcing me to play with her. That helped a lot to get out of being in a dark hole.”

Savannah Lee’s emotional support dog Veda at Flat Run Veterans Park on Wednesday, March 17. Veda sits down to take a break after she runs around and plays. Photo by Haley Parnell.

The progression towards mental health awareness has become more normalized since the pandemic, but the stigma is still there.

At UC Medical Center, Maxwell continues her work for the Pet Therapy Program, working with the pet therapy dogs helping patients in the hospital find a sense of peace. “What they do for patients is amazing,” Maxwell says. She describes an instance she witnessed with a waiting room dog walking over to a person sitting with a bandaged foot and laying on top of the injured limb. The therapy dog’s owner apologized to the patient and went to remove their dog. “The patient was like ‘No, this is the first time in six months, my foot has not hurt, please don’t take your dog away,’” Maxwell explains. “That dog knew exactly what to do.”


Haley Parnell is a 2021 graduate of the journalism program at the University of Cincinnati. She has interned at Cincinnati Magazine and has contributed to publications like The News Record, UC’s campus Newspaper, and UC News. In her free time, she enjoys painting and traveling.

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