Academic journal article Current Psychiatry

Could 'Rx: Pet Therapy' Come Back to Bite You?

Academic journal article Current Psychiatry

Could 'Rx: Pet Therapy' Come Back to Bite You?

Article excerpt

Studies showing that animals can help outpatients manage psychiatric conditions have received a lot of publicity lately. As a result, more patients are asking physicians to provide documentation to support having pets in their apartments or letting their pets accompany them on planes and buses and at restaurants and shopping malls.

But sometimes, animals hurt people. The Centers for Disease Control and Prevention reports that dogs bite 4.5 million Americans each year and that one-fifth of dog bites cause injury that requires medical attention; in 2012, more than 27,000 dog-bite victims needed reconstructive surgery. (1) If Dr. B writes a letter to support letting Ms. A keep a dog in her apartment, how likely is Dr. B to incur professional liability?

To answer this question, let's examine:

* the history and background of "pet therapy"

* types of assistance animals

* potential liability for owners, landlords, and clinicians.

History and background

Using animals to improve hospitalized patients' mental well-being dates back to the 18th century. (2) In the late 1980s, medical publications began to document systematically how service dogs whose primary role was to help physically disabled individuals to navigate independently also provided social and emotional benefits. (3-7) Since the 1990s, accessibility mandates in Title III of the Americans with Disabilities Act (ADA) (Table 1, (8) page 34) have led to the gradual acceptance of service animals in public places where their presence was previously frowned upon or prohibited. (9), (10)

Table1

Excerpts on service animals from the revised final regulations implementing the Americans with Disabilities Act

Service animals are ... dogs that are individually trained to ... perform tasks for people with disabilities, [such as] reminding a person with mental illness to take prescribed medications [or] calming a person with PTSD.

Service animals' ... work or task ... must be directly related to the person's disability. Dogs whose sole function is to provide comfort or emotional support do not qualify as service animals under the ADA.

State and local governments, businesses, and nonprofit organizations that serve the public generally must allow service animals to accompany people with disabilities in all areas of the facility where the public is normally allowed.

Service animals must be harnessed, leashed, or tethered, unless these devices interfere with the animal's work or the individual's disability prevents using these devices. In that case, the individual must maintain control of the animal through voice, signal, or other effective controls.

Source: Reference 8

If service dogs help people with physical problems feel better, it only makes sense that dogs and other animals might lessen emotional ailments, too. (11-13) Florence Nightingale and Sigmund Freud both recognized that involving pets in treatment reduced patients' depression and awdety, (14) but credit for formally introducing animals into therapy usually goes to psychologist Boris Levinson, whose 1969 book described how his dog Jingles helped troubled children communi-cate. (15) Over the past decade, using animals--trained and untrained--for psychological assistance has become an increasingly popular therapeutic maneuver for diverse mental disorders, including autism, anxiety, schizophrenia, and PTSD. (16-19)

Terminology

Because animals can provide many types of assistance and support, a variety of terms are used to refer to them: service animals, companion animals, therapy pets, and so on. In certain situations (including the one described by Dr. B), carefully delineating animals' roles and functions can reduce confusion and misinterpretation by patients, health care professionals, policy makers, and regulators.

Parenti et al (20) have proposed a "taxonomy" for assistance dogs based on variables that include:

* performing task related to a disability

* the skill level required of the dog

* who uses the dog

* applicable training standards

* legal protections for the dog and its handler. …

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