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How Emotional Support Animals Benefit Mental Health and Wellness

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How Emotional Support Animals Benefit Mental Health and Wellness

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"Having an ESA during a pandemic can help owners recalibrate their emotions and feel more reassured."

Source: study and article
Value: discusses the impact of emotional support animals during quarantine, addresses studies on the topic, is from a trusted institute

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An emotional support animal is more than a pet. They are a companion. People with mental illness go through a range of emotions each day. Support animals help their owners to control their emotions and relax. Plus, it helps that emotional support animals are ( usually) cute and cuddly.

For an animal to be considered emotional support, they must be certified. Certifications for animal companions typically come through a physician, psychiatrist, social worker, or other mental health professional. These professionals must confirm and provide support that the animal alleviates one or more symptoms of an existing disability. This confirmation must be done on their official letterhead and include the information of the individual, including that the patient does indeed have an emotional or psychiatric disability, without labeling what kind of mental illness it is. Some common mental disabilities that qualify someone for an emotional support animal (ESA) are anxiety, depression, learning disabilities, attention deficit disorder, chronic stress, and post-traumatic stress disorder.

The certification for an emotional support animal can be for any type of animal, though it is most commonly a dog. However, some other emotional support animals to consider include cats, birds, rabbits, fish, or rodents.

ESAs come with some perks. For example, an animal with an emotional support certification has unfettered access to apartment housing, even if it has a no-pet policy. It also waives any additional monthly pet fees and your ESA gets free domestic airline travel in the cabin.

However, be sure to check that you have the necessary documentation for your ESA before you fly as each airline has different requirements. For example, Allegiant requires a form from the vet to verify the health of the animal, along with the animal's certification, a document from your doctor treating you for emotional or mental disability, and a form you sign agreeing to take full responsibility for the animal.

What's the difference between ESAs and service animals?

While ESAs have access to a lot of places, there are some places where they can't go, like restaurants or malls as service animals can. That's not the only difference between service animals and ESAs. ESAs also do not require any training. Service animals are specially trained to perform a function to help their owners, like how a seeing-eye dog helps those who are blind or visually impaired navigate from place to place. Service animals may provide some emotional support as well, but they have been trained to perform other tasks that emotional support animals have not. Service animals are also fully protected under the Americans with Disabilities Act (ADA) while emotional support animals are not.

Emotional comfort is a significant contributing factor to why many people want an ESA. Emotional support animals act as home healthcare for those who are struggling with a mental illness. While doctors prescribe medications, sometimes they prescribe an emotional support animal to provide the comfort the patient needs. People struggling with mental illness have found that having an ESA decreases their anxiety and helps them fight feelings of loneliness.

Research has shown that people felt more relaxed, less anxious, and less lonely when holding or petting an animal. They also experienced a normalized heart rate, blood pressure, and reduced depression. If this peace comes from the occasional visit with an animal, imagine how a permanent companion could help ease the stress and effects of mental illness full time.

Even though animals can't talk and don't always sympathize with or understand feelings, they still provide beneficial companionship. Many owners enjoy talking to their ESAs because they know that the animal cannot judge or offer advice. Besides having someone to talk to, ESAs also help provide physical affection.

Animals require love and attention. So do humans. By pairing them together, those who need extra physical affection and companionship are able to feel that love and attention. Plus, taking care of another living creature helps people feel important and independent, which is crucial, especially for those with mental illness. Focusing on their ESA helps draw their attention away from the things that cause anxiety and help them become motivated to do things that are good for their mental health, like getting outside and going on walks. The responsibility of an animal may be a challenge, but it also gives people a sense of purpose and increased positivity.

There's no doubt that the current situation with the COVID-19 pandemic has been different. Large amounts of change can negatively affect someone with a mental illness. With so many changes happening right now, with government decisions, social distancing, quarantine, and shut down businesses, people are feeling overwhelmed.

Luckily, those with ESAs have a companion that doesn't recognize the change-though they might notice that you are home more often. So even though owners may be feeling overwhelmed and scared, their ESAs are not. The steady presence of a neutral animal can help individuals relax and focus on their ESA instead of the news. Having an ESA during a pandemic can help owners recalibrate their emotions and feel more reassured. Even if all your support animal is doing is playing with their favorite toy, that normalcy will help you feel normal too.

Emotional support animals have largely assisted people in feeling less isolated during the quarantine and social distancing period. It's no surprise that social media feeds and video conferences are full of furry friends...these are the companions helping people cope with the destruction of routine and the threat of COVID-19. While talking to someone on the phone or video-chatting a loved one can help you feel less secluded, having an animal physically present can provide an extra emotional boost.

It's no surprise that since the start of COVID-19, many animal shelters have experienced more adoptions. People in quarantine recognize the need for companionship, even if the companion is furry. The joy that comes from loving a pet greatly outweighs the isolation brought on by COVID-19.

At Alvarado Park Institute, we care about your mental health and want to help you cope with the current COVID-19 pandemic. If you have been debating whether or not to adopt an emotional support animal, now may be the time. Talk to your doctor about your mental illness and the possibility of prescribing an ESA.

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How Emotional Support Animals Benefit Mental Health and Wellness - San Diego | API

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An emotional support animal is more than a pet. They are a companion. People with mental illness go through a range of emotions each day. Support animals help their owners to control their emotions and relax. Plus, it helps that emotional support animals are (usually) cute and cuddly.

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The Effect of Service Dog Partnership on the Mental Health Status of United States Veterans

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The Effect of Service Dog Partnership on the Mental Health Status of United States Veterans

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"This study hoped to use what is already known about PTSD and apply new research questions to the existing knowledge base to help combat veterans cope, integrate, and build the resiliency they need to alleviate their symptoms, potentially through the use of service dogs. "

Source: Survey
Researcher: Colleen McLaughlin
Value: specifies a specific type of person who could use service animals, explains how service dogs can aid with PTSD, surveys genuine veterans who have first-hand experience with service dogs

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Psychiatric Assistance Dog Use for People Living With Mental Health Disorders

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Psychiatric Assistance Dog Use for People Living With Mental Health Disorders

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"PADs can be all shapes and sizes and perform a plethora of roles that provide substantial benefits to a broad range of people."

Source: Study
Researchers: Janice Lloyd, Laura Johnston, and Julia Lewis
Value: discusses a specific type of support animal, explains the variety of benefits these animals can contribute, provides a legitimate study

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Abstract

A psychiatric assistance dog (PAD) is a service dog that is trained to assist its handler (owner) who has been diagnosed with a mental health condition such as post-traumatic stress disorder (PTSD), schizophrenia, depression, anxiety, or bipolar disorder. Literature searches reveal that little is known about the population of people who own PADs, the types of dogs used or the functions they provide. One third ( n = 199) of PAD owners in Australia registered with the charity "mindDog" participated in an online survey designed to better understand the person and dog team. Participants learned about PADs through the internet (37%), health care practitioners (32%), or family/friends (30%). The dogs in the sample were of varying age, gender and breed. The most common reasons for people to choose a dog to be a PAD were temperament (60%) and size/weight (48%). Just under half (48%) of the dogs had been acquired by the owner specifically to be trained as a PAD, and the rest were existing pets. All the dogs were trained by the owner or a combination of the owner and a qualified trainer; none were trained exclusively by assistance/service dog provider organizations. The median age of the participants at the time of data collection was 47 years, ranging from 10 to 75 years. Most (77%) identified as female. Depression (84%), anxiety (social 61%; generalized 60%), PTSD (62%), and panic attacks (57%) were the most reported mental health diagnoses. Tasks the dogs performed for their owners included: reduction of anxiety through tactile stimulation (94%); nudging/pawing to bring back to the present (71%); interrupting undesirable behavior (51%); constant body contact (50%); deep pressure stimulation (45%) and blocking contact from other people (42%). PAD usage decreased (46%), increased (30%) or did not change (24%) participants' use of psychiatric or other health care services. Decrease in service use was mainly due to reduced suicide attempts, and less requirement for hospitalization and medication; increased use was mainly due to enhanced ability to attend appointments. Results of this study show that PAD owners have differing mental health diagnoses, and their dogs perform different tasks to support them in daily life. Every participant described the relationship with his/her PAD as positive, suggesting that a successful working partnership does not require the dog to have been bred or raised specifically for the role. A better understanding of this population and the person-dog relationship will inform the appropriate choice, training and use of PADs for people living with mental health problems.

Keywords: assistance dogs, disability, human-animal bond, human-animal relationships, mental health, psychiatric assistance dogs, service dogs

Introduction

Dogs and other animals have been helping people with physical disabilities and providing emotional support for centuries, with the first therapeutic use reported in the ninth century ( 1). Nowadays, assistance dogs (or service dogs) are trained to perform tasks to mitigate a range of physical, psychiatric, or intellectual disabilities for their handlers (owners) ( 2) as well as being trained for public access. A psychiatric assistance dog (PAD) is a specific type of service dog that is trained to assist its owner who has been diagnosed with a mental health condition, such as post-traumatic stress disorder (PTSD), schizophrenia, depression, anxiety, or bipolar disorder. In Australia, PADs, like other assistance dogs including guide dogs and hearing dogs, are covered under the Commonwealth Disability Discrimination Act 1992 that guarantees public access for all dogs trained as assistance dogs. PADs are distinct from emotional support dogs (ESDs) (sometimes called therapy dogs). An ESD (or other animal) is a pet that provides emotional support to an individual to relieve various disabling conditions. However, the animal is not necessarily trained to do so, and service dog legislation in Australia does not permit an ESD to access public areas where dogs are normally prohibited.

PADs can be of any breed or size suitable for the intended purpose of helping people to access public places, travel on public transport and take part in social activities that are "closed off" to them. PADs can be trained by the person who will become the dog's handler (owner-trainer) or in combination with a qualified trainer, while others are trained exclusively by assistance/service dog provider organizations. In Australia, anyone who has been diagnosed with a mental health condition by a medical doctor or other suitable health care professional is eligible to apply to accredit such a dog. However, literature searches reveal that little is known about the population of people who own PADs inclusive of mental health diagnoses, origins and types of dogs used or the functions they provide. A better understanding of peoples' needs and the relationship between owners and their dogs will help inform the appropriate choice, training and use of assistance dogs for people living with mental health issues. Hence, PAD owners (clients) registered with the charity "mindDog" were invited to participate in an anonymous on-line survey to explore these matters.

mindDog is an Australian not-for-profit organization that helps people who have been diagnosed with a mental health condition/s procure, train and accredit PADs. Information on the mindDog accreditation process can be found in Box 1 (the application form) and (assessment, training and follow-up of the person-dog team). More information on mindDog, including the training standard and the Public Access Test (PAT), can be found at www.minddog.org.au/.

Box 1

The application form for accreditation of a mindDog is in three parts and includes:

Part 1: Details about the applicant and the dog: Ensuring dogs are of an appropriate age, desexed, microchipped, registered, vaccinated, and have access to suitable veterinary care.

Parts 2 & and 3: The opinion of the applicant's health care provider, and other referee, regarding the applicant's ability to care for a dog and how the dog might assist the applicant.

The application form also seeks information on assurance of care for the dog if the owner was unable to do so.

Materials and Methods

All active clients ( N = 600) registered with mindDog in February 2018 were invited to participate in an anonymous survey via SurveyMonkey cloud-based software. Questions were forced-choice, multiple-choice, "other" (for free-text to be inserted) or binary (yes/no). Comments on peoples' relationships with their dogs were also sought. Chi-square tests for independence were performed to assess potential associations between owner diagnosis and: the tasks the dog performed, the type of dog used, and the likelihood of changes to health service utilization.

The descriptive results of the survey are presented below. The data obtained from the open-ended (comments) section on peoples' relationships with their dogs was coded into categories and themes, as per Wang and Park [( 3), p. 224] process of qualitative coding. While a full thematic analysis is outside the scope of this article, and will be published elsewhere, a synopsis of this preliminary data is presented below.

Results

Owner Demographics

One third ( n = 199; 33%) of eligible people ( N = 600) completed the survey. The median age of the participants at the time of data collection was 47 years, and age ranged from 10 to 75 years. The majority of the sample (77%) identified as female, and most (58%) lived in suburban areas. Participants learned about PADs through the internet (37%), their health care practitioner (32%), or family/friends (30%).

Depression (84%), anxiety (social 61%; generalized 60%), PTSD (62%) and panic attacks (57%) were the most self-reported mental health diagnoses of this population (), with many clients citing multiple diagnoses. Frequently reported mental health diagnoses in the "other" category included Obsessive-Compulsive Disorder, Autism Spectrum Disorder (ASD) and eating disorders.

Dog Demographics

The breed of dogs in the sample varied widely with several dozen purebred and crossbred breeds identified. Age ranged from around 1- > 10-years; gender was evenly distributed. Most dogs were acquired from a registered breeder (48%) followed by an animal shelter (21%) and non-registered breeders (16%).

The most common reasons for people to choose a dog to be a PAD were temperament (60%) followed by size/weight (48%), with only 15% of participants saying that they chose the dog based on its physical appearance. Just under half (48%) of the dogs had been acquired by the owner specifically to be trained as a PAD, and the rest were existing pets.

All the dogs were trained by either the owner or a combination of the owner and a qualified trainer; none were trained exclusively by assistance/service dog provider organizations.

Tasks

All dogs performed multiple tasks for their owners. The most common tasks performed were: reducing anxiety through tactile stimulation (grounding) (94%); nudging or pawing to bring back to the present (71%); interrupting an undesirable behavioral state (51%); constant body contact (50%); deep pressure stimulation (45%); and blocking contact from other people (42%) ().

The most common tasks listed in the "other category" were: "making" the owner leave his/her bed/house; "reminding" the owner to take his/her medication; keeping the owner "safe"; "sensing" owner's emotions and behaviors and thus preventing manifestation of an undesirable behavioral state; and providing a "reality check" from anxiety or dissociation/hallucination.

Outcomes

PAD usage decreased (46%), increased (30%), or did not change (24%) participants' use of psychiatric or other health care services. An analysis of the accompanying narrative pertaining to changes in the use of psychiatric or other health care services revealed that reductions in use of services were mainly due to reduced suicide attempts, less need for hospitalizations, and less requirement for medication. Increased service use was mainly due to enhancement of the owners' ability to attend appointments, as the presence of the dog increased peoples' confidence-both in venturing outdoors and in interacting with others.

No statistically significant associations were found between the owners' mental health diagnoses and: the tasks the dog performed, the type of dog used, and the likelihood of changes to health service utilization. No other relationships within the dataset were found.

Owner-Dog Relationship

Several themes emerged from the preliminary thematic analysis of the owner-dog relationship including: Independence; Confidence; Social function; Companionship; Safety and Hope. Every pertinent response ( n = 198) to the question: "What does your mindDog mean to you?" indicated a positive partnership, as exemplified by the following [de-identified] quotes:

"Before I had [my dog] I was so anxious I couldn't even leave the house and I had never had someone to look after before. She has changed my life so much; everyone I know says it and my psychiatrist thinks she's amazing. Once [my dog] became qualified as a minddog I have been able to travel to so many more places and be able to do things independently. I don't think I could have done that without her. This also means that I can do things on my own now that in the past I would have needed more help with or been in hospital. But I still definitely need also other health services to help me. She is very good but she can't replace everyone! But I really hope your research shows how great they are because I don't know how I would cope without her."

"My assistance dog has allowed me to become more social and allowed me to do some of the most basic life necessities ie: go shopping, leave the house, do university, feel safe when out and about and reduce my anxiety and panic attacks. By having my dog, I have managed to reduce my mental health inpatient stays to just stabilisation admission rather than crisis admission. I can now go out and be active with my children and live a fairly normal life."

Other data showed that the publics' attitude could be a cause of stress for the owner:

"When I'm with her I don't worry that I'm out, because it's like I have my home with me so it's okay. So I can only say that I am so grateful that psychiatric dogs are now recognised and I hope it only spreads more. That being said, sometimes I find having her with me stressful because sometimes other people start challenging me about having her, even though I have all her certification and ID and vest, and that's really stressful for me when people pay attention to me in such a negative way. So I hope it becomes more widely accepted and less criticised by other people who don't really understand."

Discussion

The results of the present study indicate that PADs assist people of all ages, including children, with a range of mental health problems, whose lives are often severely compromised by anxiety and fear, to access public places, travel on public transport and take part in social activities that may have been closed off to them. Although the study was a self-report measure and therefore limited by selection-bias and subjectivity, every relevant comment ( n = 198) regarding the meaning of the person-dog relationship (i.e., response to the question: "What does your mindDog mean to you?") was positive. Thus, suggesting that sound conclusions can be drawn about their efficacy.

A plethora of dog breeds were used by the participants in this study-from the Chihuahua to the Irish Wolfhound, illustrating that a PAD does not need to be a certain size or breed (or gender). Indeed, only 15% of participants chose a dog based on its physical appearance. Because PADs come in many shapes and sizes, they can look different to other assistance/service dogs such as the Labrador or Golden retriever commonly used as guide dogs ( 4). As indicated in the present study, this can lead to stress-provoking attention from the public, as unlike some people who are blind or vision-impaired or have mobility issues, there may be no outward sign of disability. Mental illness frequently carries a heavy social (and self-) stigma ( 5), and the owner may be reluctant to explain the dog's role. Public education regarding the expanding roles of contemporary service dogs and associated etiquette would help to alleviate social issues with accessibility.

It is noteworthy that over a fifth (21%) of dogs in the study were acquired from an animal shelter suggesting that "rescue" dogs can be an important source of successful PADs. Sourcing dogs from animal rescues or shelters is beneficial in reducing the number of animals killed due to overcrowding and opens up shelter space for another animal who might desperately need it.

The authors hypothesized that there might be an association between the owners' mental health diagnoses and the tasks the dogs performed, but no relationship was found. This is likely due to the variables "diagnosis" and "tasks" being highly confounded as, for example, the majority of people (84%) identified as being diagnosed with depression, and almost all (94%) dogs performed the task of "grounding" for their owners. Future research with only open-ended questions for these variables, rather than forced-choice options as per the present study, which can lead participants to make certain choices, would be valuable. While it is not yet understood what cues, whether behavioral, olfactory, or other, PADs may be responding to when performing tasks, it is clear that the relationship between individual owners and his/her dog is a personal one, influenced by each owner's diagnosis and needs.

As part of the mindDog application process ( Box 1), the applicant's health care practitioner completes a form that expresses how the practitioner expects a mindDog might assist the applicant. However, some health care practitioners may not be aware of the roles the dogs can provide, and it is likely that the functions are greater and more varied than are those predicted. Findings from the present study supports the view of the Psychiatric Service Dog Society (PSDS) in the US ( 6) that PADS be used as an adjunct to ongoing standard-of-care mental health treatments, and not as a substitution. These findings can be used to inform medical doctors and other health care providers, who play a pivotal role in their patients' application process for a "mindDog," about how the dogs may be of assistance.

A review on the effectiveness of a range of assistance animals (AA) for Australia's National Disability Insurance Agency (NDIA) ( 7) concluded that there may be large economic benefits to AA ownership, including the ability to work, attend school and concerning services no longer required (e.g., a non-verbal child with ASD who now speaks). Although evidence is limited, the results of the present study support this conclusion in that nearly half (46%) of participants said that their use of psychiatric and other health services had decreased-mainly due to reduced suicide attempts, and less requirement for hospitalization and medications. Public hospital spending in Australia has been the single fastest growing area of government spending over the past decade or so ( 8). From a health economic perspective, judicious decreased use of services and hospitalizations/use of medications is likely to save money.

Howell et al. ( 7) also recommended that should AAs be provided by the NDIA, the standard for assistance dog training (inclusive of PADs) should adopt the model of the AA provider organization selecting/breeding and training dogs for AA roles-a process that typically takes around 2 years. However, the findings of the present study suggests that successful working partnerships does not require the PAD to have been bred and/or raised specifically for the role, as every participant considered their personal and working relationship with their dog to be effective despite no dogs being acquired/trained by this method. The so-called "human-animal bond" is the dynamic relationship between people and animals that influences the psychological and physiological states essential to the health and well-being of both ( 9). Unlike many service dog organizations, mindDog works with existing pets so a strong owner-dog bond is likely to be already in place. Thus, it is the authors' opinion that while many assistance dogs (such as guide dogs, hearing dogs and others trained to assist individuals and their families impacted by disability) be exclusively acquired and trained by AA provider organizations, this approach may not be necessary for PADs. This could have far-reaching consequences for people who wish to use such a dog as waiting times and financial costs for a trained dog could be dramatically reduced.

There appears to be a growing need for PADs to help individuals with psychiatric disabilities. A recent study by Walther et al. ( 10) showed that PADs placed fourth in North American accredited placements of various assistance dogs, surpassing the number of hearing dogs placed. Indeed, the number of applicants to mindDog has doubled at the time of writing this article (9-months since gathering the data), resulting in the organization having to limit when it can accept applications. When thinking about the direction the field may take in the future it seems unlikely that PAD activities are likely to end, therefore steps must be taken to ensure the well-being of the dogs as well as the handler in this remarkable example of the human-animal bond in action. Responsible pet ownership requires a commitment to provide for all the requirements of one's pet-food, exercise, housing, reward-based training, love and affection, grooming, and veterinary care. While mindDogs only works with positive force-free training methods [as recommended by ( 11)], it is imperative for all owners to understand how animals communicate and learn, and to thoroughly research the basics of pet care before acquiring any new pet to ensure she/he has the capacity to meet the physiological, behavioral and social needs of the animal. Future research should focus on Shubert's ( 2) advice whereby handlers (and trainers) become adept in canine body language, recognize signs of stress in dogs, have realistic expectations, and ensure only dogs with the appropriate temperament be trained as PADs.

Conclusion

This study has contributed to the small but growing body of research on PADs including the demographics of people who use these dogs in Australia, the origin and type of dogs used and the functions the dogs provide. PADs can be all shapes and sizes and perform a plethora of roles that provide substantial benefits to a broad range of people. In addition to training, it appears that for a satisfactory relationship, PADs do not require to have been bred or raised specifically for the role, but that success hinges on the human-animal bond. An understanding of the relationship between owners and their dogs will help inform the appropriate choice of dog, training and use of assistance dogs for people living with mental health issues to better support the needs of both species.

Ethics Statement

The study was carried out in accordance with the recommendations of James Cook University Human Ethics Committee ( Ethics Approval Number H7210) with informed consent from all subjects. The participants in the study were clients of mindDogs, and had been diagnosed with a mental health condition by a qualified health professional.

Author Contributions

JaL, LJ, and JuL contributed to the design, delivery and analyses of this work. JaL wrote the article with the approval of LJ and JuL, who have critically revised the content. JaL, LJ, and JuL agree to be accountable for the content.

Conflict of Interest Statement

LJ is a board member of the charity mindDog. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Acknowledgments

The authors wish to thank the people who participated in this study (and their dogs). The authors also wish to thank the staff and board of mindDogs for their support throughout the process, in particular Cath Phillips and Gayl O'Grady. The views in this publication do not necessarily reflect the views of the charity mindDog.

References

1. Bustad LK, Hines LM. Historical perspectives of the human-animal bond. In: Anderson RK, Hart BL, Hart LA, editors. The Pet Connection: Its Influence on Our Health and Quality of Life. Minneapolis, MN: Center to Study Human-Animal Relationships and Environments; (1984). p. 15-29. [ Google Scholar]

3. Wang GT, Park K. Student Research and Report Writing: From Topic Selection to the Complete Paper. Chichester: Wiley Blackwell: (2016). [ Google Scholar]

5. Corrigan PW, Druss BG, Perlick DA. The impact of mental illness stigma on seeking and participating in mental care. Psychol Sci Public Interest. (2014) 15:37-70. 10.1177/1529100614531398 [[ PubMed] [ CrossRef] Google Scholar]

6. Esnayra J. Help from man's best friend: Psychiatric service dogs are helping consumers deal with the symptoms of mental illness. Behav Healthcare. (2007) 27:30-2. [[ PubMed] Google Scholar]

10. Walther S, Yamamoto M, Thigpen AP, Garcia A, Willits NH, Hart LA. Assistance dogs: historic patterns and roles of dogs placed by accredited facilities and by non-accredited U.S. facilities. Front Vet Sci. (2017) 10.3389/fvets.2017.00001 [[ PubMed] [ PMC free article] [ CrossRef] Google Scholar]

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Psychiatric Assistance Dog Use for People Living With Mental Health Disorders

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A psychiatric assistance dog (PAD) is a service dog that is trained to assist its handler (owner) who has been diagnosed with a mental health condition such as post-traumatic stress disorder (PTSD), schizophrenia, depression, anxiety, or bipolar disorder.

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Confirming the benefits of emotional support animals

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Confirming the benefits of emotional support animals

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"These benefits include calming and relaxing, lowering anxiety, alleviating loneliness, enhancing social engagement and interaction, normalizing heart rate and blood pressure, reducing pain, reducing stress, reducing depression and increasing pleasure."

Source: Article
Author: Cynthia K. Chandler
Value: reveals an author's perspective on the matter, discusses pros and cons of emotional support animals, indicates how service animals can be greatly helpful

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Have you received a telephone call of the following nature? "Can you certify my pet to be an emotional support animal?"

If you are a professional counselor, then the likelihood of you receiving such a request is on the rise. This is because word is spreading that the U.S. Department of Housing and Urban Development (HUD) recognizes the benefits of emotional support animals and provides regulations allowing them to live with an owner in designated nonpet housing (with a few exceptions) without requiring a pet deposit fee.

Exercising this right does not require that an animal be certified. What it does require is documentation that an individual has a legitimate need for an emotional support animal. The responsibility of providing this documentation lies with professional counselors and other mental health or health providers. In 2008, HUD stipulated that "persons who are seeking a reasonable accommodation for an emotional support animal may be required to provide documentation from a physician, psychiatrist, social worker or other mental health professional that the animal provides support that alleviates at least one of the identified symptoms or effects of the existing disability."
Documentation and other considerations
A counselor who chooses to provide such documentation must do so in letter format on the counselor's letterhead. The documentation should state that:

1) The named individual is under the counselor's care

2) The individual has an emotional or psychiatric disability

3) The counselor recommends the individual have an emotional support animal to assist with the disability

The letter is provided directly to the individual who wants to have an emotional support animal live in the home. The individual can then choose with whom to share the letter.

In the documentation, the counselor does not label, define or describe the particular disability of the client. Rather, the counselor must state in general terms that the client has an emotional or psychiatric disability and that an emotional support animal can alleviate one or more of the symptoms or effects of the disability. Individuals need only provide proper documentation to a landlord to have a pet live with them as an emotional support animal in housing typically designated as excluding pets. The judicial system has interpreted this right to fair housing to additionally extend to individuals who wish to have emotional support animals live with them in college or university housing facilities, such as residence halls, dormitories or university-owned apartments.

The responsibility of providing documentation that would allow individuals to have an emotional support animal live with them should not be taken lightly. Based on the accompanying symptoms of a client's emotional or psychiatric disability, a professional must determine whether living and engaging with an emotional support animal in the home might provide the client with some relief from the disability. To make this determination, it may be useful to have some understanding of how an animal may alleviate symptoms or effects of an emotional disability. Fortunately, there is research that provides guidance in this area.

In my 2012 book, Animal Assisted Therapy in Counseling, I reviewed several research studies on the psychophysiological and psychosocial benefits of positive social interaction with a pet, such as holding or stroking an animal. These benefits include calming and relaxing, lowering anxiety, alleviating loneliness, enhancing social engagement and interaction, normalizing heart rate and blood pressure, reducing pain, reducing stress, reducing depression and increasing pleasure. Based on the results of these studies, it is plausible that living with an emotional support animal may alleviate symptoms associated with a number of emotional and psychiatric disabilities. HUD states, "Emotional support animals by their very nature, and without training, may relieve depression and anxiety, and/or help reduce stress-induced pain in persons with certain medical conditions affected by stress."

Another factor to consider in recommending that a client have an emotional support animal is whether the client has the ability and desire to properly care for an animal. Although human-animal interaction is known to assist people with developmental, emotional, social and behavioral disorders, it is important to assess whether any impairment is so severe that an animal would be neglected or harmed.

Dogs are the most common species to serve in the role of emotional support animals, but Section 504 of the Rehabilitation Act and HUD's Fair Housing Act (FHAct) do not designate species restrictions for this role: "While dogs are the most common type of assistance animal, other animals can also be assistance animals."
Emotional support animals vs. service animals
HUD legislation uses the broad term "assistance animals," which is inclusive of both service animals and emotional support animals, when addressing the right to fair housing for individuals with these animals. In contrast, the fair housing rights and rights of access to other facilities included in the Americans with Disabilities Act addresses service animals only. To be clear, an emotional support animal is not the same as a service animal or a psychiatric service animal. Thus, emotional support animals do not have the same federal rights of access to facilities as do service animals. HUD provides the only current federal legislation that covers rights regarding emotional support animals, and this legislation is specific to allowing individuals to have animals live with them as emotional support in designated nonpet housing without financial penalty.

In 2013, HUD clarified that an emotional support animal is not merely a pet: "An assistance animal is not a pet. It is an animal that works, provides assistance or performs tasks for the benefit of a person with a disability, or provides emotional support that alleviates one or more identified symptoms or effects of a person's disability." However, HUD also stipulated that emotional support animals "do not need training to ameliorate the effects of a person's mental and emotional disabilities." Furthermore, "For purposes of reasonable accommodation requests, neither the FHAct nor Section 504 requires an assistance animal to be individually trained or certified."

There are no qualification requirements for determining whether a specific pet is appropriate to serve as an emotional support animal. So, by default, an emotional support animal is basically a person's pet that lives with that person and provides emotional support. HUD does stipulate that housing providers are not required to provide accommodations if an animal is destructive, poses a direct threat to the health and safety of others or interferes with the ability of a facility to perform its intended purpose. So, in practice, most people with proper documentation can have a pet live with them and serve in the role of emotional support animal as long as the animal is not destructive, disruptive or dangerous.
Recommendations
Because federal law does not require emotional support animals to be trained or certified, the potential exists for some of these animals to be unpredictable and cause harm. Until there is greater oversight regarding emotional support animals, I recommend that counselors avoid a chain of liability and not name a specific pet to serve as an emotional support animal. When providing documentation, refer only to the benefit of the individual having an emotional support animal, but do not name a specific animal. The decision concerning the specific pet to be designated as an emotional support animal should be made by the individual owner of the pet. It is not the responsibility of the counselor or other mental health provider to sanction the appropriateness of a particular pet to serve as an emotional support animal. That is not to say that counselors should avoid assisting individuals in the decision-making process regarding emotional support animals.

For instance, counselors can recommend that clients have their pets evaluated by a qualified evaluator before designating the pets to serve as emotional support animals. A standardized evaluation can often determine if an animal possesses the appropriate stamina and temperament to serve in this role.

Evaluation is important for health and safety reasons. Some animals may find the role of emotional support animal to be too stressful, and the emotional and physical health of the pet will be damaged. We must not overlook the welfare of the animals when considering whether they might provide emotional support for individuals with emotional and psychiatric disabilities. In addition, some pets can respond to stress with overprotective tendencies and aggression, putting members of the public at risk.

Many individuals desire to have their emotional support animals accompany them to pet-restricted facilities outside the home. Many businesses and institutions today are wrestling with how to make this happen while still maintaining the safety of those who may come in contact with these animals. It is my opinion, as a very experienced handler and animal team evaluator, that if individuals were to have their pets' temperament evaluated by a qualified evaluator, both initially and periodically (say every two years), and provide current documentation that the animal had passed a standardized temperament evaluation, then they might be granted permission by a business or institution on a case-by-case basis to have their emotional support animal accompany them to places where pets are typically not allowed.
Animal temperament evaluations
Animal temperament evaluations assess the animal's social attitude and behavior toward both people and a neutral test dog. In addition, the evaluation assesses the animal's ability to walk politely on a leash, interact with a small crowd of people and respond to a variety of basic obedience commands by its handler. Failing a temperament evaluation would not interfere with the right of an individual to have the pet live in the home in the role of emotional support animal. Federal law protects this right. Qualified animal temperament evaluators can be found through national organizations such as the American Kennel Club (AKC) Canine Good Citizen (CGC) program and the national Pet Partners program.

The AKC website (akc.org/dog-owners/training/canine-good-citizen/) provides information about the CGC evaluation, which is best suited for the simple purpose of determining if a pet is well-behaved enough to be around the general public. However, it is designed solely to evaluate the temperament of dogs, not other species. The CGC evaluation is relatively inexpensive, takes about 30 minutes to complete and requires the handler to take the dog through a series of basic obedience commands. Local CGC evaluators can be found at many large pet stores that offer dog training for handlers or at community obedience training clubs. The Pet Partners organization offers evaluations for a number of different domestic animal species, but the investment in cost and effort is higher. This is because the intended purpose is to register Pet Partners teams that can provide services to the public as handler and therapy animal (note that a therapy animal is not the same as an emotional support animal). The Pet Partners registration requires a rigorous handler-team evaluation - for temperament, skills and aptitude - and requires the handler to complete a training that is available online or through an eight-hour, in-person workshop. The training includes learning about risk management and infection control procedures that are valuable to follow when a pet is engaging with the public. The Pet Partners website (petpartners.org) provides information on training and finding a local evaluator.

The animal temperament evaluation procedure may resolve a prominent ethical dilemma. If an emotional support animal can alleviate or assist with a person's emotional or psychiatric disability at home, why shouldn't the animal be allowed to serve this purpose outside of the home as well, such as in the classroom or a work environment? At the same time, because no oversight exists regarding behavioral requirements for emotional support animals, how do businesses and institutions protect the public from danger posed by a potentially unruly animal? Because there is no federal regulation that requires facilities other than housing to allow the presence of emotional support animals, then businesses and institutions can establish their own policies around this issue.

Requiring a standardized animal temperament evaluation may be a reasonable solution to this ethical quandary. The business or institution could provide a letter of access, for a designated period of time, to an individual accompanied by an emotional support animal if that person provides the institution with:

1) Official documentation from a professional counselor, or other mental health or health provider, designating the need for an emotional support animal (this could be the same documentation used for federal housing rights)

2) Proof that the animal passed a recently administered standardized temperament evaluation from a reputable source such as AKC or Pet Partners (the evaluation should have been completed within the past two years because appropriate animal temperament can deteriorate over time)
Advocacy
Perhaps the greatest source of confusion today is around the concept of emotional support animals. The general public may not be aware that emotional support animals are not the same as psychiatric service animals and therefore do not have all of the same federal rights to access facilities. Many people are unaware that current federal law does not require emotional support animals to be trained or evaluated. Thus, some emotional support animals with inappropriate temperament may pose a risk to the general public. Generally, the public does not realize that most emotional support animals are essentially a person's pet serving in the role of emotional support.

I am an advocate for the idea of emotional support animals, but I firmly believe there should be greater oversight. This would include evaluation of the appropriateness of a pet to serve as an emotional support, taking into consideration both the prospective health and welfare of the animal and the health and welfare of the public, particularly if the animal is to accompany the individual to facilities outside the home. Current federal law clearly states that an emotional support animal does not have to be trained or certified to be allowed to live with a person, implying that the animal does not have to be evaluated either. But federal law does not make stipulations about access to facilities other than the home for emotional support animals. Thus, businesses and institutions are free to make policies that allow individuals to be accompanied by their emotional support animals, while also providing for the safety of the public.

Counselors can more effectively advocate for their clients if they understand federal regulations pertaining to emotional support animals. Additionally, this information is beneficial for protecting the general public from those who might misrepresent the role of their animal or the right for the animal to accompany them into pet-restricted areas. Unfortunately, profit opportunists exist who encourage such misrepresentation by selling (to anyone who is willing to pay) an official-looking - yet completely unofficial - vest for a pet to wear and a worthless "certification" document that may ultimately confuse the public about the legitimate role of the animal and the rights of the individual the animal is accompanying.

Federal advocacy for those with emotional or psychiatric disabilities, through recognition of the right to have an emotional support animal in the home, is a positive development in our society. Moreover, businesses and institutions that recognize the potential benefits of allowing an emotional support animal to accompany a person with a disability outside of the home reflects enhanced sensitivity to human welfare.

Animals are an excellent source of nurturance and companionship. Creating additional yet responsible opportunities for human-animal interaction enhances people's lives. Movement toward greater integration of well-behaved animals into our daily lives at home, school and work is a reflection of enlightened social evolution.

****

Cynthia Chandler is a professor of counseling and director of the Consortium for Animal Assisted Therapy at the University of North Texas. She is author of the book Animal Assisted Therapy in Counseling (2012). Contact her at cynthia.chandler@unt.edu.

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Confirming the benefits of emotional support animals - Counseling Today

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Have you received a telephone call of the following nature? "Can you certify my pet to be an emotional support animal?" If you are a professional counselor, then the likelihood of you receiving such a request is on the rise. This is because word is spreading that the U.S.

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The growing trend of emotional support animals

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The growing trend of emotional support animals

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"A patient with an anxiety problem can takes a pill to calm down, and the effects of the drug are measurable and backed by scientific testing and research. But Younggren says there is very little evidence to scientifically support that animals ameliorate a patient's symptoms."

Source: Article
Author: Jeffrey Younggren
Value: offers a counter-claim to the regularly accepted idea, discusses the dangers of false claims about mental illness

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A dog in the grocery store; a cat in the cabin of an airplane; a bird in a coffee shop -- companion creatures labelled as Emotional Support Animals (ESAs) are showing up more and more in places previously understood to be animal-free. It's part of a growing trend which includes "certifying" animals to provide emotional assistance to a person with a diagnosable mental condition or emotional disorder.

Jeffrey Younggren, a forensic psychologist and clinical professor at The University of New Mexico's Department of Psychiatry and Behavioral Sciences, recognized the growing trend presents an ethical challenge for therapists asked to certify emotional support animals for their patients. "Emotional Support Animal Assessments: Toward a Standard and Comprehensive Model for Mental Health Professionals" outlines the ethical challenge and offers possible solutions to better serve both people who feel they need ESAs and those who must comply with the animals such as landlords and airlines.

In their third paper on this topic, published by the American Psychological Association, Younggren and his coauthors propose a four-prong standard assessment model for practitioners to follow when asked to provide a patient with an ESA certificate. These guidelines include:

1. Understanding, recognizing and applying the laws regulating ESAs.
2. A thorough valid assessment of the individual requesting an ESA certification.

3. An assessment of the animal in question to ensure it actually performs the valid functions of an ESA.

4. An assessment of the interaction between the animal and the individual to determine whether the animal's presence has a demonstrably beneficial effect on that individual.

"In this model, you have to take the animal into consideration. Somebody has to certify that the animal is able to do what you're asking it to do. And there are avenues by which animals can be evaluated regarding their capacity for these kinds of experiences," Younggren adds.

For example, a patient with an anxiety problem can takes a pill to calm down, and the effects of the drug are measurable and backed by scientific testing and research. But Younggren says there is very little evidence to scientifically support that animals ameliorate a patient's symptoms.

By making such guidelines and practices standard, the hope is that there will be fewer instances like the one recently, which resulted in a flight attendant needing stitches after being bitten by an emotional support animal.

According to Younggren, service animals must be trained to provide a function otherwise inaccessible to their owner. But ESAs are not held to that standard, which is partially what his new research aims to correct.

"Our research has nothing to do with service animals. Seeing eye dogs and therapy dogs are animals that help individuals manage their disabilities in certain situations -- but that's not what an ESA is. An ESA is an example of a well-intended idea that has metastasized and developed into a world of nonsense," Younggren said.

Cassandra Boness, University of Missouri Ph.D. candidate and second author on the paper, says the model will better align ESA certifications with professional and legal practices, while also providing guidelines for mental health practitioners.

"One of our biggest goals is to disseminate this information in order to better educate mental health providers, as well as policy writers, about the need for ethical guidelines around ESAs," Boness said.

In addition, Boness said her hope is that this paper will encourage others to pursue research on the impacts of ESAs on patients, so that there is a more scientific pool of data to cite.

"Mental health professionals who lack full awareness of the law will likely fail to recognize that writing such letters constitutes a disability determination that becomes a part of the individual's clinical records," the paper states.

Currently, in order to receive waivers for housing or travel purposes where animals are banned, the law requires patients must have a mental or emotional condition diagnosable by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). If patients are given certifications for an ESA, it means they, and the therapist signing the certification, are declaring the patient to be psychologically disabled with significant impairment in functioning.

"[The guidelines] will require that those individuals who certify these animals must conduct a comprehensive evaluation of the individual to determine that they have a disability under the DSM-5," Younggren concluded. "That disability has to substantially interfere with the patient's ability to function, which is what the ADA requires. And the presence of the animal has to ameliorate the condition, which means you have to see the person with the animal."

Should this proposal influence an industry standard, Younggren says it will become more difficult for people to receive certification, but on the whole safer for society.

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disorders and syndromes; mental health; psychiatry; dogs; life sciences; wild animals; scientific conduct; poverty and learning; space policy

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The growing trend of emotional support animals: Researchers propose standard assessment for certifications

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Emotional Support Animals (ESAs) are showing up in places previously understood to be animal-free. The growing trend includes 'certifying' animals to provide emotional assistance to a person with a diagnosable mental condition or emotional disorder. New research outlines the ethical challenge and offers possible solutions to better serve both people who feel they need ESAs and those who must comply with the animals.

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University Counseling Centers’ Perceptions and Experiences Pertaining to Emotional Support Animals

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University Counseling Centers’ Perceptions and Experiences Pertaining to Emotional Support Animals

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"And, only 47.18% of UCCs write official diagnosis letters in support of disability accommodations."

Source: First-hand Account
Authors: Lori R. Kogan, Karen Schaefer, Phyllis Erdman, and Regina Schoenfeld-Tacher
Value: offers first-hand accounts, specifies on the impact of service animals on students and in a learning environment, explains different ways of how they can be good/bad based on the way they're implemented

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ABSTRACT
Increasing numbers of students are requesting accommodations for emotional support animals (ESAs) in higher education settings. Since the legislation pertaining to this type of service animal differs from the laws governing disability service animals, colleges and universities are faced with developing new policies and guidelines. A sample of 248 University Counseling Centers (UCCs) completed a survey about student requests for ESA letters of support from their counselor. The UCCs were also asked if they issue official disability diagnoses for clients. Responses showed that UCCs are not yet being asked to write many letters of support for ESAs-56.9% almost never do it, and 31.05% do it only several times per year. And, only 47.18% of UCCs write official diagnosis letters in support of disability accommodations. Yet, most UCCs are aware of the need for official policies in this arena. This article provides general recommendations for establishing university policies.

Acknowledgment

We would like thank all the college counseling centers and faculty/staff who participated in this survey and shared their current policies and procedures. We also want to acknowledge and thank all those who have posted their policies online. Examples of a compilation of these policies are available upon request.

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University Counseling Centers' Perceptions and Experiences Pertaining to Emotional Support Animals

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ABSTRACT Increasing numbers of students are requesting accommodations for emotional support animals (ESAs) in higher education settings. Since the legislation pertaining to this type of service animal differs from the laws governing disability service animals, colleges and universities are faced with developing new policies and guidelines.

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The power of support from companion animals for people living with mental health problems: a systematic review and narrative synthesis of the evidence

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The power of support from companion animals for people living with mental health problems: a systematic review and narrative synthesis of the evidence

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"Qualitative studies illuminated the intensiveness of connectivity people with companion animals reported, and the multi-faceted ways in which pets contributed to the work associated with managing a mental health condition, particularly in times of crisis."

Source: Multi-Study Review
Researchers: Helen Louise Brooks, Kelly Rushton, Karina Lovell, Penny Bee, Lauren Walker, Laura Grant, Anne Rogers
Value: offers various perspectives (pros and cons) of support animals, offers research from many different studies, includes both qualitative and quantitative research

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Abstract

Background

There is increasing recognition of the therapeutic function pets can play in relation to mental health. However, there has been no systematic review of the evidence related to the comprehensive role of companion animals and how pets might contribute to the work associated with managing a long-term mental health condition. The aim of this study was to explore the extent, nature and quality of the evidence implicating the role and utility of pet ownership for people living with a mental health condition.

Methods

A systematic search for studies exploring the role of companion animals in the management of mental health conditions was undertaken by searching 9 databases and undertaking a scoping review of grey literature from the earliest record until March 2017. To be eligible for inclusion, studies had to be published in English and report on primary data related to the relationship between domestic animal ownership and the management of diagnosable mental health conditions. Synthesis of qualitative and quantitative data was undertaken in parallel using a narrative synthesis informed by an illness work theoretical framework.

Results

A total of 17 studies were included in the review. Quantitative evidence relating to the benefits of pet ownership was mixed with included studies demonstrating positive, negative and neutral impacts of pet ownership. Qualitative studies illuminated the intensiveness of connectivity people with companion animals reported, and the multi-faceted ways in which pets contributed to the work associated with managing a mental health condition, particularly in times of crisis. The negative aspects of pet ownership were also highlighted, including the practical and emotional burden of pet ownership and the psychological impact that losing a pet has.

Conclusion

This review suggests that pets provide benefits to those with mental health conditions. Further research is required to test the nature and extent of this relationship, incorporating outcomes that cover the range of roles and types of support pets confer in relation to mental health and the means by which these can be incorporated into the mainstay of support for people experiencing a mental health problem.

Electronic supplementary material

The online version of this article (10.1186/s12888-018-1613-2) contains supplementary material, which is available to authorized users.

Keywords: Pets, Mental health, Systematic review, Narrative synthesis, Self-management, Personal communities, Networks of support

Background

The rise in people experiencing a mental health problem [ 1] and the identification of mental illness as the leading cause of disability adjusted life years globally (DALYs) [ 2, 3] requires concerted effort in identifying and mobilising resources to support people living with a mental health problem. Traditional approaches to the self-management of long-term conditions focus on psychological mechanisms of behaviour change, which have been shown to have some utility for managing symptoms. However, these approaches often fail to take into account the wider resources including material and social relationships in people's domestic and local environments which form the latent and constituent part of systems of lay and community support [ 4]. These are increasingly being recognised as holding significant relevance for the management of long-term health conditions [ 5]. Indication of the potential benefit that pets convey to the experience of mental health comes from evidence detailing the benefits of pet ownership in relation to stress reduction, improved quality of life, and pets as promoters of social and community interaction [ 6- 8]. Recent work has shed light on the relevance of pets in the social networks of people who have received a diagnosis of a severe and enduring mental health illness (e.g. Schizophrenia and Bipolar disorder) [ 9] suggesting that pets can be considered alongside other human relationships. However, the evidence base for the benefit of pet ownership for those with diagnosable mental health conditions is fragmented and unclear.

The enduring relationship between humans and domestic animals is well documented and there are an estimated 10 million cats (23% of households with one or more cat) and 11.5 million dogs (30% of households with one or more dog) kept as pets in the UK [ 10], with similar rates of ownership found across Europe, Australia, China and Japan [ 11]. Despite this phenomenon, the potential benefits that owning a pet might confer specifically to mental health has received relatively little attention. Research has focused on formalised animal contact in closed settings such as Animal Assisted Therapy (AAT). Multiple reviews have considered AAT in a variety of fields including intellectual disability [ 12], autism [ 13], general healthcare [ 14, 15] and neuro-rehabilitation [ 16, 17], but there are no systematic syntheses of the role and effects of the less structured animal contact provided by pet ownership in open settings for people with mental health conditions. The provision of ongoing support in normalised everyday settings remains an aspiration of mental health policy but the mapping of the nature of resources available and how they are, and can be, deployed remains underexplored.

Underlying theoretical framework

This review draws on a framework of long-term condition 'work' informed by Corbin and Strauss [ 18] which was developed in the context of exploring the contribution and division of labour provided by intimate and weak ties in personal communities in relation to living with a long term condition [ 4, 5, 19, 20]. This approach allows for an in-depth analysis of the role of pets in relation to the tasks that need to be done to manage mental health in the context of people's everyday lives to consolidate the evidence base in this regard. Practical work consists of tasks undertaken by network members which are practical in orientation and includes general practical activities such as housekeeping, personal care and diet and exercise activities but also illness specific practical tasks such as taking medication, understanding symptoms, making appointments and preventative work to avoid crises. Emotional work relates to wellbeing, providing companionship and being a source of comfort when worried about everyday matters or specific illness matters. Biographical work relates to the tasks and generation of ontological security, required to retain a positive sense of identity and give life meaning again post diagnosis. This involves assessments of personal expectations, capabilities, relationships and biographical events. These types of work are distributed amongst weak as well as close ties [ 21]. This framework has been used in preference to more traditional notions of social support as it allows for the inclusion of an in-depth understanding of the open system resources, networks and relationships that people draw on when managing a long-term condition in their everyday lives [ 4]. The framework was used to guide the narrative synthesis of the studies included in the review.

This review aimed to explore the nature, extent and quality of the evidence demonstrating the role of pet ownership for people with mental health conditions.

Review questions

1. What is the nature, extent and quality of the evidence demonstrating the role of pet ownership for those with mental health conditions, with or without comorbid physical health conditions?

2. What is currently known about the mechanisms underlying any impact?

Methods

A comprehensive search of 9 electronic databases was undertaken in March 2017. The methods and reporting of the results of this systematic review are described according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines [ 22].

Eligibility criteria

The review sought to identify studies that reported primary data, which investigated the relationship between pet ownership and diagnosable mental health conditions. Inclusion/exclusion criteria can be found in Table . All participants in the sample had a diagnosable mental health condition or mental health problems associated with a diagnosed physical health condition. Papers were excluded if it was unclear who the sample were and could only be included if specific reference to diagnosable conditions was made.

Table 1

Inclusion criteria

Exclusion criteria

English language paper

Not an English language paper

Primary data

Not primary data (e.g. systematic or review article/opinion piece)

Peer reviewed journal article/conference paper/research dissertation

Not a peer reviewed journal article (e.g. books/book chapters)

Related to pet ownership and domestic animals

Studies unrelated to pet ownership (e.g. Animal assisted therapy which does not involve the direct ownership of domestic animals)

Related to the impact of pet ownership on diagnosed mental health conditions or co-morbid mental health related to long-term physical conditions.

Not related to the impact of pet ownership on diagnosed mental health conditions or mental health components of long-term physical conditions or the nature of the sample was unclear.

Studies were not excluded by date of publication or sample size. However, those that were not published in the English language, were only published in abstract form, or were not accessible via inter-library loan were not included in this review.

Search strategy and data sources

Electronic database searches were undertaken in March 2017 from the earliest record to March 2017 using ASSIA, CINAHL Plus, Embase, International Bibliography of the Social Sciences, Medline, PsychInfo, Social Science Full Text, Sociological Abstracts, and Web of Science. Grey literature sites were also searched including OpenGrey, Index to Theses, Electronic Theses Online Services, The Health and Social Care Information Centre Website and the Association of Health Observatories Website.

The search strategy was organised around four key areas: 1) Participants' perspectives, 2) Pet ownership, 3) Diagnosed mental health conditions or co-morbid mental health related to long-term physical conditions and 4) impact of pets on mental health management. The search strategy was informed by published reviews, discussion within the wider project team, consideration of MeSH terms and the wider literature in the area of pet ownership. HB piloted search terms in a number of databases with input from an information technology specialist. Papers identified through piloting were assessed for additional terms, subject headings and key words with the aim of further refining the search strategy. A copy of the final search strategy is available from the author. Within each PICO component agreed search terms were combined using the Boolean operator 'OR' and across components using 'AND'. The search was adapted for the individual databases and websites as required.

Review strategy

Search results were uploaded to Endnote before removing duplicates and exporting into the data management software Covidence ( https://www.Covidence.org). The first stage of the review process involved single screening at the level of title and abstract (see Table for a list of inclusion and exclusion criteria). An additional reviewer independently reviewed all excluded references for validity purposes. Full texts of included articles were obtained for the purposes of full text screening. Full texts were screened for inclusion independently by two reviewers and inclusion/exclusion conflicts were resolved by a third reviewer. Acceptable concordance was predefined at 90% [ 23]. A concordance rate of 93% was achieved at first rating (29 exclusion/inclusion conflicts).

The reference lists of included papers were also manually searched for relevant papers. A Google Scholar alert was created in February 2017 and stopped in August 2017, which did not identify any additional articles for inclusion.

Data extraction

Electronic forms were created in Microsoft Excel for the purpose of data extraction. Data was double extracted independently by two authors who each extracted all studies. Disagreement between extractors, which consisted of mostly minor additional detail, was resolved by consensus between authors.

The aim of the review was to explore the impact of pet ownership on diagnosed mental health conditions (or co-morbid mental health symptoms associated with other long-term conditions). Where data was available from quantitative and qualitative outcomes of mental health, these were extracted along with data relating to study design, included participants and other contextual factors.

Quality assessment

Included articles were assessed for relevance by HB, KR and AR and for quality by HB and KR using criteria adapted from the Qualitative Research Review Guidelines - RATS and the Quantitative Assessment tool for Quantitative Studies [ 24]. Any disagreements were resolved by discussion between authors. The quality assessment included assessment of potential bias in terms of selection and response and the reliability and validity of the methodology utilised. No study was excluded on quality alone [ 25]. Studies were given one point for each quality criteria the study met (see Additional files 1 and 2) and this was used to guide the narrative synthesis of the studies included in the review.

The quality assessment process generated an average quality rating of 5.5 out of 10 for qualitative studies and 8.75 out of 10 for quantitative work (refer to Additional files 1 and 2). There were no RCTs evaluating the impact of pet ownership on diagnosed mental health conditions.

Data synthesis

A deductive, thematic synthesis approach was constructed collaboratively between two authors (HB, KR) and the resultant analytical framework was elaborated and checked by a third (AR). Quantitative and qualitative data were synthesised and combined in parallel. Primary findings in each study were coded in line with the concepts of the networked work of illness management identified above which identified a set of three core types of work deployed by social network members of an individual's personal community of support ( practical, emotional and biographical work). We utilised a constant comparative approach to analysis to enhance the likelihood that concepts were translated successfully from one study to another [ 26]. Descriptive themes emerged which were used to describe groups of codes within each category of work. Using the framework we were able to draw comparisons between these themes and move beyond the primary findings presented within each individual paper. Individual benefits and disadvantages of pet ownership were considered in terms of the conditions and contexts they emerged from.

Results

The search resulted in 17 studies for synthesis; the flow of studies is outlined in Fig. . All study characteristics and quality indicators are detailed in Additional files 1, 2, 3 and 4. Of the 17 studies, 8 were conducted in the USA [ 27- 34], 4 in the UK [ 9, 35- 37], 2 in Canada [ 38, 39] and 1 each in the Netherlands [ 40], Australia [ 41], and Sweden [ 42]. Twelve of the studies were reported in journal articles [ 9, 27, 30, 32- 35, 38- 42] and 5 were part of doctoral research [ 28, 29, 31, 36, 37]. Eight of the studies used qualitative methodology [ 9, 27, 28, 31, 34, 36, 37, 42], 6 were quantitative [ 29, 30, 33, 38- 40] and 3 used mixed methods [ 32, 35, 41]. Methods used in the qualitative work included grounded theory [ 32, 36] thematic analysis [ 41, 42] phenomenology [ 28, 31] and framework analysis [ 9]. Quantitative studies employed cross-sectional survey design and used a variety of descriptive statistics [ 29, 30, 32, 33, 35, 39- 41] correlational analysis [ 41] and regression analysis [ 29, 33, 35, 40].

All participants in the studies resided within the community and had either a diagnosed serious mental health condition [ 9, 30- 32, 38, 39], mental health problems associated with a physical health condition [ 29, 33- 35, 40, 41], mental health problems associated with a developmental disorder [ 37, 42] or self-reported mental health conditions [ 27, 28]. Two of the studies involved interviews with parents of children who had a family pet [ 37, 42], the remaining studies collected data directly from participants with a companion animal. Twelve of the studies included all types of companion animals [ 9, 27, 31- 36, 39- 42] and four specifically focused on either dogs and/or cats [ 28- 30, 38]. A total of 1727 pet owners were involved in the included studies.

Of the 17 included studies, 15 reported positive aspects of pet ownership for people experiencing mental health problems [ 9, 27- 30, 32- 40, 42] and 9 reported negative elements [ 9, 27, 32, 35, 36, 38, 39, 41, 42]. Neutral effects of pet ownership were reported in some of the included quantitative studies, where no difference in mental health outcomes, social contacts or loneliness were reported for pet owners compared to non-pet owners [ 29, 32, 35, 40]. Benefits were mostly demonstrated through qualitative data, and negative elements, which were highlighted, were largely over-shadowed by co-occurring positive impact of pets in these studies [ 9, 27, 32, 35, 36, 38, 42].

Themes

Emotional work - alleviating worry, providing comfort and mitigating against feelings of isolation and loneliness

Evidence from quantitative studies relating to contribution of pets to emotional work was mixed. There were significant findings for the benefits of canine companionship for military veterans with post-traumatic stress disorder (PTSD), including effects on reducing feelings of loneliness, depression, worry and irritability, and increased feelings of calmness [ 30] and there was some evidence for the direct effect of pets on depression and mood [ 30, 35] through close proximate contact and stroking [ 35]. However, this finding was not wholly supported by other quantitative studies, which reported neutral or small negative effects of pet ownership [ 29, 35, 40, 41]. A study investigating the effect of pet ownership and strength of attachment on depression found that pet owners were just as likely as non-pet owners to be depressed [ 33]. However this focussed on the sequela of depression not its alleviation or contribution of pets to managing post diagnosis. Interestingly, a study by Siegel found that pets had an effect in mediating the relationship between AIDS diagnosis and depression and that there was a weak trend towards dogs being more successful in this role than cats [ 33].

The importance of pets in relation to the provision of emotional work was a recurrent theme in the numerous qualitative studies included in the review where people reported a profound connection with their pet [ 9, 27, 30- 32, 38, 39] sometimes preferring relationships with pets over relationships with other humans [ 37] and viewing pets as replacement family members [ 32]. The mechanisms through which pets made the perceived contribution to emotional work seemed to be the provision of a consistent source of comfort and affection [ 9, 34, 36, 41, 42]. This constant presence meant that this provision was available instantaneously without request [ 9, 27, 36, 42]. Pets provided calming support and were perceived to have a 'sense' of when it was needed.

Pets were able to provide unique emotional support as a result of their ability to respond to their owners in an intuitive way, especially in times of crisis and periods of active symptoms [ 9, 30, 31, 35, 36]. A related impact on loneliness was achieved through physical contact which reduced feelings of isolation [ 28, 36], providing a source of physical warmth and companionship [ 35], and by providing opportunities for communication [ 34, 36].

The study by Ford found that people were able to confide in their pets when they were unable to open up to other people.

In this respect, pets provided a safe environment where people can talk without fear of being judged or being a burden to others [ 9]. This was echoed in work where people reported that their dogs allowed them to express their feelings and clarify their thoughts without the concern that they will interrupt, offer criticism or advice, or betray confidence [ 30, 31].

The sentiment of pets being non-judgemental underpins the absence of conditionality, which was a recurring finding in included studies. Pets provided unconditional love and affection [ 9, 30, 31, 34, 42] which fostered self-acceptance and congruence [ 28]. Pets constituted a source of support which people could trust and rely on compared with other social network members [ 9]; they provided simple relationships free from conflict [ 28] and they did not overstep boundaries [ 31]. The latter seems to be particularly beneficial for people with Autism [ 37] and PTSD [ 30].

By providing unconditional positive regard, pets promoted emotional stability through the regulation of feelings, management of stress and helping people to cope with difficult life events [ 27, 42]. For people living alone, pets provided a source of 'connectedness' [ 27], reassurance, and normalcy [ 31].

Practical work - physical activity and symptom distraction

Quantitative data implicating pets in the practical work associated with mental health management pointed to the impact of dog ownership on physical activity [ 40] and self-reported quality of life related to physical health [ 29]. One study found that those with pets were more significantly likely to use ambulatory mental health care than those without [ 40].

Qualitative results from the studies expanded on illness specific practical work including in times of crisis [ 9, 28, 30- 32, 35- 38, 41, 42]. The main mechanism through which pets appeared to contribute to practical work was through the ability of pets to distract and disrupt attention from symptoms or upsetting experiences such as hearing voices, panic attacks or suicidal ideation [ 9, 27, 28, 30- 32, 34, 36]. Pets contributed to practical work directly and indirectly by acting as a form of bridging tie to additional resources.

One quantitative study by Stern and colleagues [ 30] demonstrated that whilst participants with PTSD did not report feeling less affected by painful memories or flashbacks they indicated that their pet tried to cheer them up when experiencing symptoms, indicating that the presence of their pet may have lessened a modicum of the negative impact of trauma [ 30].

Qualitative data pointed to the way in which pets were able to undertake the activities of practical work because of their consistent and proximate presence and through providing the opportunity for reciprocity [ 9, 27, 31, 34, 36]. Pets' contribution to practical work is seemingly made possible through the provision of opportunities for routine tasks required to care for an animal, providing a positive focus for activity [ 9, 27, 30- 32, 34, 36, 42], providing a needed challenge [ 36], by introducing humour into situations [ 9], providing a direct grounding role [ 30, 31, 38], lessening the negative impact of symptoms [ 9, 30] and reducing the stress associated with the vagaries of living with their condition [ 34]. One study found that participants felt that they required less medication because of this pet contribution [ 31].

Pets could contribute to a sense of preparedness to take self-management action through increasing people's positivity and self-efficacy [ 32, 34, 41, 42]. They encouraged their owners to stay in the present avoiding worry and ruminations about past behaviours [ 28, 30] or concerns about the future [ 34]. Pets were also considered important in terms of providing protection for their owners [ 28, 31]. This was particularly of value for those participants experiencing the constant vigilance associated with Post Traumatic Stress Disorder [ 31].

Owners felt that their pets could sense when practical support for mental health was required and acted accordingly [ 9, 28, 31, 42]. However, this was not universal to all studies indicating the impact of pets cannot be fully explained by this behavioural initiation [ 37].

Indirectly, pets encouraged a form of behavioural activation. Pets were seen to enhance mobility [ 41], increase exercise [ 30, 35, 36, 40] and promote contact with nature [ 30, 36] all of which were considered beneficial to mental health.

Pets as conduits to social interaction and emotional nourishment

A feature of the role attributed to pets in terms of mental health management in the qualitative data was the various ways in which they facilitated the quality and quantity of social interactions. Pets reportedly increased social interaction with others including friends and family [ 34] and with more peripheral social interactions [ 9, 38]. They also fostered a sense of social and community integration [ 9, 32, 35, 36, 38, 42]. Interestingly, one study found that dogs increased social interactions that would not have been possible without their pet (e.g. other dog walkers [ 36]). This was supported by some [ 39] but not all of the included quantitative studies [ 29, 32, 39, 40] indicating a complicated relationship between pets and social interaction which may be mediated by type of pet and/or number of pets [ 22].

The reasons identified in the included studies as to why pets were considered useful in terms of enhancing the amount and quality of social interactions included having the confidence to venture into new social situations with their pet, owners finding it easier to be in the presence of other people when their pet was present [ 30], being more open during social interactions [ 28] and being able to have difficult conversations with existing friends and family through their pet [ 34, 36].

Biographical work - identity, a sense of self-worth and existential meaning

The data implicating pets in biographical work was mostly derived from the qualitative data. Two quantitative studies addressed this type of work; one found that despite a low effect score, pet owners performed significantly higher than non-pet owners on meaningful activity scales [ 39] and another found that since getting their pets individuals felt better about themselves as people [ 30].

Qualitative data suggested that pets provided their owners with a sense of purpose and gave meaning to their lives [ 41]. Often participants described how this had been diminished since diagnosis with a mental health condition but that pets helped them to overcome this and provided them with a platform for going forward with their lives [ 9, 38]. This sense of meaning and purpose included pets giving their owners a reason to live [ 9, 32], to contributing to a sense of control and empowerment [ 9, 31, 32, 35] and giving individuals hope for the future [ 9, 31]. This was considered particularly important when people were feeling consumed by illness or when self-management felt out of control [ 32].

Owners' felt that their pets contributed directly to maintaining a consistent sense of identity and self [ 9, 27, 32, 36, 39, 41]. They felt pets provided a form of validation through the pride associated with successfully caring for a pet [ 9, 28] but also as sustaining elements of pre-illness identities including roles of mother, pet owner or animal lover [ 9, 36] and as being a protector of animals [ 28, 31].

Pets were also considered relevant in terms of mediating how other people viewed them [ 9, 42]. Pet ownership connected their owners to valued activities such as hobbies [ 35] and were considered a culturally sanctioned meaningful occupational and social role [ 38, 39]. One study also indicated that the mastery achieved through the training of animals also contributed to a positive sense of self [ 9].

Participants described elements of relationships with pets that were important to their mental health including the nature of relationships as simple and reciprocal, pets as understanding and honouring personal boundaries and pets not holding past behaviours against them [ 9, 27, 32, 36, 39, 41]. These components were often missing from other human relationship and were considered important aspects of the human/pet dyad [ 9].

Pets impacted directly on the management of negative perceptions and experiences related to a diagnosis of mental illness which arose either from themselves or from others within and outside of their existing social networks [ 9, 28, 31, 34, 35, 39]. The mechanisms through which this appeared to operate included counterbalancing a loss of social status as a result of being diagnosed with a mental illness, providing non-judgemental acceptance often not available elsewhere [ 9], making owners feel wanted and valued [ 34, 39] and encouraging owners to feel good about themselves [ 28, 30]. One study proposed that companion animals symbolised abused childhood selves and that by caring for a pet they may have symbolically been caring for this part of themselves [ 28].

Negative aspects of pet ownership

Despite an overall sense of the positive impact of pet ownership on the management of diagnosed mental health disorders, some negative aspects surfaced within individual quantitative and qualitative studies. This included aspects such as financial costs and housing situations, the burden of pet ownership especially if pets were unruly which could be detrimental to mental health and the guilt that owners experienced if this was not managed successfully [ 9, 35, 36, 38, 39]. Horses and dogs were considered the most burdensome in this regard and research highlighted the importance of matching pets to individual circumstances [ 36]. The early stages of pet ownership were often the most difficult for people but were concomitantly considered as an important investment in terms of future support and companionship [ 35]. Pets could also be seen as a barrier to aspirational goals associated with recovery such as travel [ 9, 35].

The potential or actual loss of beloved companion animals was a major source of distress for owners [ 9, 32, 38, 42] but it was acknowledged that joy could still be taken in their memories once death had been come to terms with [ 32] and that such experiences could facilitate understanding of other difficult life events [ 42].

Participants described how other people including health professionals were often concerned about the safety of their pets and their ability to care for them [ 27, 33]. Siegel et al. demonstrated that those with HIV felt there was a perception that they should not have pets as a result of their condition [ 30]. This may also apply to those with mental health conditions but this was not covered in any of the included papers.

Discussion

This review represents the first attempt to systematically identify and synthesise evidence related to the benefits of pet ownership for those with diagnosed mental health conditions. The majority of relevant data extracted for purposes of this review were qualitative and high quality prospective experimental studies were distinctly lacking. This indicates that the evidence in relation to the role of pets for the management of diagnosed mental health conditions is at an early stage and currently disparate and exploratory in nature. The use of thematic analysis informed by an existing framework led to the identification of a number of mechanisms through which companion animals were seen to support their owners to manage their mental health conditions. Very little data fell outside of the framework and what did related mostly to the demographics of pet owners. The results support the wider health benefits of companion animals for the general population [ 6- 8]. However, the discrepancy often identified between quantitative and qualitative findings within the review and the range of factors mediating the relationship between pets and their owners identified within existing literature speaks to the complexity of this relationship. Mediating factors included the type of pet [ 33], the number of pets [ 30], perceived friendliness of pet [ 41] and attachment to pet [ 33].

Pets were implicated in emotional work because they provided a consistent and proximate source of calming support and companionship [ 9, 27, 30- 32, 38, 39]. This was enhanced through a perception that animals could intuit when such support was needed and act accordingly providing a depth of connection that was considered particularly useful in time of crisis [ 9, 30, 31, 35, 36]. Companion animals contributed to practical work through their role in the distraction and disruption from upsetting symptoms and experiences [ 9, 27, 28, 30- 32, 34, 36] through the provision of routine and a role in behavioural activation [ 32, 34, 41, 42]. Pets were considered important in the maintenance of a positive identity and sense of self because of the reciprocity associated with human-pet dyads [ 9, 27, 32, 36, 39, 41], a perception that pets accepted their owners without judgement, the sense of pride associated with successfully caring for an animal [ 9, 28] and supporting the management of felt and enacted stigma [ 9, 28, 31, 34, 35, 39]. Qualitative data demonstrated the relative strength of the role of pets in relation to all three types of work but quantitative data was unavailable to unanimously support this impact particularly in relation to practical and biographical work where quantitative evidence was distinctly lacking. Existing quantitative studies failed to include measures which adequately addressed the potential roles of companion animals as identified within the qualitative data such as self-efficacy and preparedness to take action.

Despite the mixed evidence from the quantitative data, the participants included in the review enjoyed keeping their animals and believed that they gained psychological benefit from these relationships as demonstrated by the thick descriptions derived from the qualitative data. The review demonstrated that those with diagnosable mental health problems can infer the same benefits from pet ownership as the general population and pets may have a particular role in terms of enhancing quality of life given that levels of social exclusion and stigma are likely to be greater for this population [ 9, 32, 35, 36, 38, 42].

Participants felt that their pets faciltiated the quality and quantity of existing social interactions and forged new relationships acting as a bridging tie to emotional nourishment [ 9, 32, 34- 36, 38, 42]. This is likely to be of increasing importance given that social isolation is both a cause and effect of mental illness and that those with mental illness are considered one of the most socially isolated social groups [ 43].

Despite these identified benefits, it appeared that relationships with companion animals are not considered or incorporated into health care planning or wider health related discussions of consultations [ 9]. The contrary appears to occur where individuals are advised against pet ownership or experience negative attitudes from health professional in relation to their pet [ 33, 34]. This indicates pet ownership can create additional work for professionals in terms of managing and advising people and highlights the need for a focus on professional attitudes, which is currently lacking from the evidence base.

The findings call for cultural changes in policy towards the way in which pets can be incorporated with other support in open systems which is often left untouched or unconsidered by formal service provision. A different logic of care is required; one which values the harnessing of available and valued support identified by people, which supports individuals' capacity to undertake valued activities (such as dog walking) and looks for support which does not engage them in unequal power relationships which can sometimes be anti-therapeutic. With increasing emphasis being placed on evidence based health care, such macro-level policy changes are likely to necessitate strengthening the underpinning evidence base given the low quality of evidence identified within the review. Further exploration of the implementation feasibility and optimal implementation models may also be required, including the potentially important role of inter-agency and third sector working.

Negative aspects of pet ownership identified in the review included concerns about potential, and the significant distress associated with the actual loss of a pet supporting previous research [ 44]. Evidence from those involved in natural disasters such as hurricanes suggest that pet loss can add considerably to acute trauma and increase the risk of long-term impacts [ 45, 46]. This highlights the potential for the loss of an animal to be of greater impact for those with diagnosable mental health conditions given the intense and positive identification reported with their pet and suggests the need to consider pets in planning and delivery of mental health care.

Strengths and limitations

This review gains its strengths from the combination of rigorous search and extraction methods and the underlying theoretical framework which guided the analysis. To guard against bias in the undertaking of the review, two reviewers independently extracted all data and where disagreement occurred, these were discussed between authors until agreement was reached.

The level of quality across included studies was a limiting factor in this review with an average quality rating of 5.5 out of 10 for qualitative studies and 8.75 out of 10 for quantitative work (refer to Additional files 1 and 2). There was also a lack of randomised trials evaluating the impact of pet ownership on diagnosed mental health problems. This is perhaps unsurprising given the pragmatic difficulties associated with randomising individuals or families to be pet or non-pet owners within RCTs. Prospective experimental or quasi-experimental designed studies should be used to compare outcomes for pet owners and non-pet owners using measures that adequately incorporate the range of tasks in relation to each type of work as identified within this review. Given the potential benefits which might be conveyed by pets for people with mental health conditions, there is a clear need for further rigorous, high quality research, in order to consolidate these existing findings and build an evidence base on which commissioners and policy makers can base decisions.

As part of our inclusion criteria, we included only those with a diagnosable mental health problem or mental health components of a diagnosable physical health condition which may have impacted on the studies included in our review.

Conclusion

Despite some inadequacies in the data, this review suggests that pets provide benefits to those with mental health conditions through the intensity of connectivity with their owners and the contribution they make to emotional support in times of crises together with their ability to help manage symptoms when they arise. Further rigorous research is required to test this relationship, incorporating outcomes that cover the range of roles pets may have in relation to mental health identified within this review. The research studies included in this review provide a point of debate that services and policy makers may wish to consider in the future.

Additional files
Additional file 1: Additional file 2: Additional file 3: Additional file 4:(18K, docx) (20K, docx) (19K, docx) (18K, docx)
Acknowledgements

The authors would like to thank Rebecca Pedley for her advice and support during the review process and Shu Eu and Katie Robinson for their contributions to the early stages of the review process.

Funding

This is a summary of independent research funded by the National Institute for Health Research (NIHR)'s Programme Grants for Applied Research Programme (Grant Reference Number RP-PG-1210-12007). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

Availability of data and materials

Data sharing is not applicable to this article as no datasets were generated or analysed during the current study.

Abbreviations

AAT

Animal assisted therapy

AIDS

Acquired immunodeficiency syndrome

DALYs

Disability adjusted life years

HIV

Human immunodeficiency virus

PRISMA

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

PTSD

Posttraumatic stress disorder

USA

United States of America

WHO

World Health Organisation

Authors' contributions

HB, KR, PB and AR were involved in the design of the review. HB, KL, KR, LG, LW were involved in screening the identified papers. KR screened all included and excluded studies for validity purposes. AR scrutinized all included studies. HB and KR read all included papers and independently extracted data. HB, KR developed the initial analytical framework which was elaborated on and checked by AR. PB and KL were regularly consulted in the conceptualisation of the paper. All authors read and approved the final manuscript.

Notes

Ethics approval and consent to participate

Not applicable

Consent for publication

Not applicable

Competing interests
Electronic supplementary material
The authors declare that they have no competing interests.

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Footnotes

The online version of this article (10.1186/s12888-018-1613-2) contains supplementary material, which is available to authorized users.

Contributor Information

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The power of support from companion animals for people living with mental health problems: a systematic review and narrative synthesis of the evidence

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There is increasing recognition of the therapeutic function pets can play in relation to mental health. However, there has been no systematic review of the evidence related to the comprehensive role of companion animals and how pets might contribute to ...

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Service dogs benefit the well-being of their handlers, research shows

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Service dogs benefit the well-being of their handlers, research shows

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"A recent study, led by the Purdue University’s College of Veterinary Medicine, shows how service dogs can have measurable positive effects on the health and wellbeing of individuals with physical disabilities."

Source: Study/Article
Researcher: Kerri Rodriguez and Maggie O’Haire
Value: from a credible school, describes impacts of service dogs, discusses mental impact on both those with physical health and mental health challenges

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Service dogs benefit the well-being of their handlers, research shows

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Low self-confidence. Social isolation. Longing for independence.