Author Topic: ESA Letter  (Read 378 times)

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Offline Cailee-j

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ESA Letter
« on: October 07, 2017, 11:00:40 PM »
I am in the process of getting my dog certified as an ESA. I had made an appointment with my general physician to see if she would write the letter. The reason I chose her over a mental health professional is because my anxiety/panic attacks mainly causes problems with my disease(which is a invisible disability). So I was thinking that it would be better to have a healthcare professional who was familiar with my disability and what causes issues with it. While doing further research though, I have read several times that the letter HAS to be from a mental health professional. Does this mean that a letter from my physician would not suffice? Would I then have to reach out to a mental health professional and instead ask them to certify my dog?
I am pretty lost right now, trying to sort out all of the information I have read and would definitely appreciate any help in clarifying. Thanks!

Offline SandyStern

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Re: ESA Letter
« Reply #1 on: October 08, 2017, 08:57:07 AM »
I'm pretty sure any M.D. will be considered a "mental health professional."

Offline Kirsten

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Re: ESA Letter
« Reply #2 on: October 08, 2017, 10:13:24 AM »
It has to be from whomever is treating you for the mental illness.  In some cases that will be a primary care physician.  In other cases it will be a specialist.  Primary care physicians are licensed to treat mental illness just as they can work in a wide variety of areas.  They just aren't specialists.  But it has to be someone who has diagnosed you with a mental illness and is treating you for it.
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Offline Kirsten

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Re: ESA Letter
« Reply #3 on: October 08, 2017, 10:23:27 AM »
Clarification:  a mental health care professional is a person who is licensed to treat people for mental illness.  Sometimes this individual is a specialist, such as a psychiatrist, psychologist or therapist.  Sometimes it is a general practitioner (a generalist), such as a primary care physician.  It would not be, say, an ophthalmologist, cardiologist, or radiologist because they are not generalists and they are not mental health specialists either.  They don't treat people for mental illness professionally.

It's based on a DSM-IV diagnosis.  So ask this:  would an insurance company pay out for a treatment billed under a DSM-IV code?  The DSM-IV is the manual used for diagnosing and coding mental illnesses essentially for insurance billing.  So, would an insurance company pay for treatment of a mental illness by a radiologist?  No.  They'll pay for radiology services billed by a radiologist, but not mental health care services billed by a radiologist.

Is this written down clearly anywhere?  No.  It's not a rule, but an explanation of how the DSM-IV comes into it.  That it has to be a DSM-IV diagnosis is explicit in guidances for the ACAA, and that it has to be a mental healthcare professional who is treating the person.  But they don't spell out what constitutes a mental healthcare professional because it is assumed one would go to someone whose job it is to treat mental illness for treatment for mental illness.  So I'm trying to explain why that assumption is, and how it is IMPLIED by them specifying the DSM-IV.
« Last Edit: October 08, 2017, 10:30:00 AM by Kirsten »
Kirsten and Tardis
In loving memory of Cole (1/11/99 - 6/26/12)  He gave me back my life.

"The one absolute, unselfish friend that man can have in this selfish world -- the one that never proves ungrateful or treacherous -- is his dog." -George G. Vest

Offline Moonsong

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Re: ESA Letter
« Reply #4 on: October 08, 2017, 10:40:20 AM »
I just wanted to pop in and add that there is no such thing as certification for an ESA. Any certification/registration website that you find is likely a scam.
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Offline Kirsten

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Re: ESA Letter
« Reply #5 on: October 08, 2017, 11:06:39 AM »
There are actually two similar, yet different threads being discussed.  I didn't catch on at first.  But there is information on the other thread that is not present in this one.  Maybe the first thread spawned the question of this thread?

Anyway, the OP (original poster, or topic starter) knows certification and registration are a scam.  :wink:
Kirsten and Tardis
In loving memory of Cole (1/11/99 - 6/26/12)  He gave me back my life.

"The one absolute, unselfish friend that man can have in this selfish world -- the one that never proves ungrateful or treacherous -- is his dog." -George G. Vest

Offline Cailee-j

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Re: ESA Letter
« Reply #6 on: October 08, 2017, 11:20:44 AM »
Sorry about that! I wasn't sure how to connect my two posts  :blush: Thank you again for all of the help, this is a difficult process for me and I want to ensure I am doing everything legitimately and properly, I do not want anyone to think I am "scamming" the system and so am trying to get all the information I can before I proceed.
On another note, I have not been diagnosed with a mental health disorder but do see a counselor to help deal with severe anxiety and intermittent panic attacks. Sorry to be repetitive, but I would have to get a proper diagnosis from my physician saying I have anxiety that affects my disability before my physician could decide if an ESA is the right treatment for me?

Offline Kirsten

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Re: ESA Letter
« Reply #7 on: October 08, 2017, 02:37:52 PM »
I can combine the two threads if you like.  They actually are different topics, it's just that some information is pertinent to both questions.

So there are only two situations when it matters whether the animal is designated an emotional support animal:  on commercial aircraft and in "no pets" housing.  You've mentioned flying (and I'll be honest I have some concerns there that haven't yet been addressed).  If you are allowed to have your dog in whatever housing you currently live in, then you don't need to worry about that.  For example, I own my home, so it wouldn't matter whether my dog was considered a pet or an emotional support animal or a service animal in my home.  I can call him an emotional support animal or a black bear if I like, it's up to me since I don't have to answer to a landlord who might have rules about pets.

Because each of these two situations is governed by a different regulatory agency and under a different federal law, there are slight differences in how it works.  For example, the Department of Transportation, which regulates air travel and the Air Carrier Access Act, have their opinion about how it works and they've actually spelled it out very clearly in various regulations and guidances but Housing and Urban Development, which regulate most types of housing and the Fair Housing Act, have NO regulations explicitly talking about either emotional support animals or service animals and yet they have one about pets for the elderly, disabled and those living in public housing.

So when you talk about ESAs or ask questions, it's important to be clear on the context, whether it's for flying (as in this case) or for housing, in order to get the most accurate responses.

When it comes to your actual treatment, that is entirely between you and the mental health professional you've decided to work with.  Whatever you two agree together on treatment is no one's business but yours and theirs.  Sure we have a bunch of people who have personal experience with mental illness, anxiety, panic attacks, etc., and if you ask for suggestions on treatment options or what people prefer and why, you can get all kinds of answers, but my point is that there are no regulations about what is "valid" treatment concerning an ESA or whether it's a valid or appropriate treatment component, or how the animal might be used in conjunction with treatment.  That's your private concern with your provider.  It's going to be very individual because you and your condition are very individual.

For the letter for air travel, there are several very specific things that must be in the letter.  These are spelled out in regulations and some airlines want it exactly to the letter in the right form while others don't seem to much care so long as they get the letter.  So generally it's best to follow the recipe exactly since that will work for any airline, regardless of whether it is picky or not picky.

Going from memory here but the letter must
1.  Have a date that is no more than a year old
2.  Be on a mental health professional's letterhead
3.  Include the licensing information of the treating professional
4.  State that the individual is under that professional's treatment
5.  State that the professional considers the person to be either disabled or substantially limited in their ability to perform major life activities (should list the major life activities for best results)
6.  State that the individual has been diagnosed with a mental illness which appears in the DSM-IV
7.  State that in the professional's professional opinion, the presence of the emotional support animal is necessary for a reason that is directly related to the disability either during the flight OR at the destination.  So, for example, if you have a double amputee, it might be emotional support for depression resulting from the loss of both legs and the trauma surrounding the loss, though they don't have to go into even that much detail.  It could just be a statement like "emotional support for the treatment of depression resulting from being disabled."

Here's our article, including a sample letter if your doctor is interested in using a sample instead of trying to formulate one from scratch:  http://servicedogcentral.org/content/ESA-flying

There's a link in that article to the actual wording in regulatory law that spells out what has to be in the letter.  I've reinterpretted it a bit to make it easier to understand and included some extra bits that I've learned over the years that make things ultimately easier.  For example, I don't think it explicitly says in the aircraft regulations that the letter has to explain the relationship between the disability and the animal, but it does in housing case law and guidances, so I'm just covering the bases because generally things go better when the airline is completely satisfied with the letter and doesn't feel a need to contact the doctor for clarification.  It reduces stress IMO if you're picky about the letter way in advance instead of dealing with details right before flying or on the day of departure.  I'm all about reducing stress, especially for someone who by definition is mentally ill and statistically probably has some pretty bad depression and/or anxiety already.

The concern I alluded to earlier:  You're concerned about how your dog will handle the stress of flying and yes, it can be stressful.  I'm concerned whether flying with your dog, at least at this stage, is ultimately going to decrease or increase your own anxiety.  One or the other of you needs to be very chill with this plan in order to help the other to keep it together.  If you are both anxious, you could wind up making each other even more anxious and it could be a very emotionally distressing and draining experience for all.  I would like for you to have the best outcome possible, even if it means asking you to consider whether flying with her is your best option at the moment.  I suggest that you consider not just how much better it might be if it goes well, but how much worse it might be if it does not go well.  The problem with a plane and a dog who isn't used to planes is that if it gets overwhelming for her you have no opportunity to get her out of that situation until the end of the flight.  In just about any other situation you would have the option to simply leave the moment it got to be too much and go home, but not during a flight.  I suggest this is something you talk over with your therapist, counselor, doctor, or whomever is treating you.  I can't begin to guess which is going to be the best choice for you because I barely know you.  All I ask is that you consider it very carefully with guidance from your mental health care professional so you make the best possible choice for you.
« Last Edit: October 08, 2017, 02:40:56 PM by Kirsten »
Kirsten and Tardis
In loving memory of Cole (1/11/99 - 6/26/12)  He gave me back my life.

"The one absolute, unselfish friend that man can have in this selfish world -- the one that never proves ungrateful or treacherous -- is his dog." -George G. Vest