What Are The Benefits And Drawbacks of Using a Psychiatric Service Dog?
An overview of the good and bad aspects of working with a Psychiatric Service Dog to help mitigate symptoms of mental illnesses such as Depression and Anxiety.
Trigger warning for mentions of self-harm and suicide, though only in concept and not with any details.
Also note the following is meant entirely as relating personal experiences. It is not intended as nor should it be taken as medical advice. Please consult with your doctors before attempting any course of treatments.
Psychiatric Service Dogs. They are cute, they are smart, they are helpful, and have we mentioned they are seriously very cute?
But are they for you?
Well there's the kicker.
If you go into online Service Dog communities you'll see the question come up again and again: Is a Service Dog right for me? It comes from people with all kinds of disabilities, with all kinds of backgrounds, and with the same uncertainty that a lot of people have as they realize just how much a disability is affecting their life. Am I sick enough? Do I need this? Do I qualify? Am I even allowed to ask?
Now I'm no doctor so obviously I cannot give medical advice. What I am is someone who works with a Psychiatric Service Dog so I can at least give you the benefit of my experience both in the actual working with a dog and in the research I put into it for myself. This is by no means meant to substitute discussions with the medical professionals involved in your care. But hopefully it can at least give you an introduction and a place to start figuring out what you need to know.
Also note: I am based in the United States so everything I talk about here in terms of laws refers to the US. Other countries handle things differently so if you are outside of the US be sure to check the specifics for where you live.
What is a Service Dog and Why Does Proper Terminology Matter?
When we talk about types of animals which help people in medical related ways, there are three categories: Service Animals, Emotional Support Animals, and Therapy Animals. Though the names can sound similar, their definitions are very different and those differences are important in terms of your legal protections.
According to the ADA, "Service Animals are defined as dogs that are individually trained to do work or perform tasks for people with disabilities." (emphasis mine and more on this in a sec). Broadly speaking, Service Animals have the legal right to accompany their handler anywhere the handler goes. There are some exceptions to this rule but if you're thinking about things like the right for someone to take their dog onto a plane, into a restaurant, or into a store, you're thinking of Service Animals. The most obvious example of a Service Animal is a seeing eye dog who helps someone who is visually impaired.
Emotional Support Animals (ESAs) are animals recognized by a doctor as providing a comforting or other benefit to a person simply by being there. There is no requirement for ESAs to be trained in any way, nor is there one that they have to be dogs. There is no fundamental difference with the animal in terms of being an ESA or a regular pet. The difference is in the doctor's note. Having the doctor's note provides some legal benefit, such as the ability to have the animal in housing that otherwise does not allow pets. ESAs also used to be legally allowed on planes, but due to abuse of the system the law was changed to no longer allow it.
Therapy Animals are animals which have been trained to provide comfort to people in group settings, such as patients in hospitals, elderly people in nursing homes, or people who have recently lived through a traumatic event such as a fire or a school shooting. Therapy animals do have training, but their training is focused on behaving well in public and interacting with multiple people. Put another way, though there can be overlap in what they both do and even who they help, Service Animals cannot be Therapy Animals nor vice versa. Think of it like if you had someone who knew how to drive a bus and someone else who knew how to drive race cars: yes there's similarities but not to the point where the two of them could switch jobs at the drop of a hat.
The confusion with the terms comes from two problems. One is with the more specific category of Psychiatric Service Animals. Because of the word "psychiatric" people immediately assume psychiatric = emotional support = therapy. If you look at the update to the regulations about airlines you can see even they had to clarify that these are not the same thing. If this was a school vocabulary test where you had to circle words which could be synonyms, the grouping would be correct. But when we are talking about the law the answer is a firm and very important NO.
The second is, quite frankly, with people who abuse the system. Now I want to stress I am in no way putting down ESAs. They are a legitimate thing and provide legitimate benefits. However, the minimal requirements for an animal to be classified as an ESA leave the door open for rampant abuse which sadly far too many people take advantage of. Combine this with a lack of education about the laws and you have people letting their unleashed dogs run loose in clothing stores because "Oh that's my therapy support dog so you're not allowed to stop me!"
Again, this is why terminology matters. The law uses very specific wording for very specific protections and thus you need to do this too. I cannot stress enough how important it is to get the vocabulary right. Not just because the more of us who use the proper terminology means the less confusion in the world, but also because using the right terminology means cutting down on a lot of work when it comes to getting the rights you need under the law.
Put it this way: I live in a complex which does not allow dogs. When I sat down in a meeting with the president of the Board and the complex's lawyer to talk about getting a Service Dog, the meeting took five minutes because the lawyer took one look at my letter, said "Oh it's a Service Dog, that's the end of the discussion then, she's fine." and that was that.
I'm not saying that using the right terminology is going to be the same thing as magic words that mean you will never have any hassles ever (more on these in a bit) but they will significantly cut down on the hassles you are likely to encounter. The right words mean something to lawyers, mean something to the law, and even help with a quick google if you've got to tell a store owner what the ADA actually says about your well behaved Service Dog vs that unleashed "serving emotional therapy dog" which just peed under a display of shirts you were hoping to browse through.
Also as a note on the legalities, it's worth it to stress that in the United States there is no such thing as Service Dog registration or certification. Your Service Dog is required to be licensed and registered the same as any other dog according to the rules of your town, but there is no Service Animal registration or certification system. Anyone telling you that there is is either a scammer trying to get money out of you or someone who was tricked by one. You may as well write "Certified Service Dog no for realsies this is legit" on the back of a paper towel for all the legal power it has. Don't fall for it and please educate others so they don't fall for it either.
What is a Psychiatric Service Dog?
Now that we understand what the heck a Service Dog is, let's talk about Psychiatric Service Dogs specifically.
As you might guess, since Service Dog means a dog "trained to do work or perform tasks for people with disabilities" then the psychiatric part refers to the disability type, which is to say mental health issues. Because mental health issues aren't necessarily as easy to quantify as something like the ability to see, we have to be careful to ensure that the tasks the dog is being trained in are not just related to the disability but are actually tasks. This is what makes the difference between a Psychiatric Service Dog vs an ESA.
For example, when I'm feeling the effects of Major Depressive Disorder, petting my dog may help me feel better but that's not a task she's performing. That's simply her being an adorable dog. However, if I'm trapped in a panic attack and signal her to come get me out of it by applying deep pressure therapy until I can breathe again, that's a task because she had to be trained how to do it and it directly relates to mitigating a symptom of my disability.
There are other things she does for me and other things that Psychiatric Service Dogs can do. Some things, like Deep Pressure Therapy or interrupting self-harming behaviors, are common enough that trainers tend to already know about them as options. Others may be things you need to come up with as you talk with your doctors. This website has a list of some suggestions which you can use to help with brainstorming. (Note that the website is related to a training center. I don't know anything about them as trainers so this isn't me endorsing them, I'm only using their site because they put together a good list.)
As I say, threading the needle of "useful thing which is actually a task" vs "hey dogs are neat" is tricky. The ADA has a FAQ which touches on it and is worth a read, not just in terms of understanding what counts as a task but also other rules and regulations about Service Animals.
In order to help you start thinking about this decision for yourself, let's take a step back.
What Are The Disability Related Benefits of a Psychiatric Service Dog?
Obviously dogs are cute, but as we just discussed being cute isn't considered a benefit from a legal perspective. So what does a Psychiatric Service Dog bring to the table that other therapeutic options don't?
For starters, Psychiatric Service Dogs help in ways therapy and medication can't. Now this is not to knock therapy or medication by ANY means. I use both and am a firm advocate for them. But therapy and medication have their own benefits and limitations. Some people need medication but not therapy, some need therapy but not medication, some need both, and some - such as my case - hit the limits of what both can do.
In my case part of my problem was that my Depression and Anxiety were not responding to medication. My psychiatrist and I went through many, MANY options and the various meds we tried either didn't work or actually made me worse. The medications I'm on now help but only in the sense that if on a scale of 1 to 10, 10 being the worst, I went from being constantly at a 9 to now hovering at a 7. It's improvement but it's not a great life. Clearly other tools were needed.
Of the various possible options, the dog stood out because Psychiatric Service Dogs are useful if you respond well to animals. In my case it wasn't just that I had a history of having pets who of course I was very fond of, but because I had a history of strong bonds with those pets. For example, the reason why I didn't commit suicide the last time I went through a struggle with my mental illness was because I couldn't abandon my cat.
I'm not saying that this sort of intense history is a requirement of getting a Service Dog, but it's something that can help inform the decision. Put another way, if I hated animals that would've been the end of the discussion. But since I loved animals and formed good relationships with them, that was a sign that a Service Dog might work for me in ways other treatments might not.
Another benefit is that Psychiatric Service Dogs can provide multiple forms of aid from one source. Now to be clear, some people need more than one Service Dog depending on their disability. But at bare minimum one dog can be trained to perform multiple tasks. So instead of having to carry and/or keep track of multiple things at once, I can bring one dog with me and have everything I need. Plus the dog is mobile on its own. As we sometimes joke in the Service Dog community, sure a weighted blanket could provide me with deep pressure therapy but unlike a heavy blanket my dog can carry herself.
Speaking of the Service Dog community, I saw one of the most helpful questions about getting a Service Dog from there. Specifically: If a robot could do every task you want a Service Dog to perform, would you get one?
The thing that I love about this question is that 1) it removes the cute factor from the equation and 2) it forces you to define the tasks as tasks. It's not about some sweet and wonderful animal who licks your face with joy when you wake up in the morning, it is about you and the needs of your disability. Psychiatric Service Dogs can help IF your disability needs can be defined in a way that a repeatable action could help with.
Because ultimately what any Service Dog does is learn tricks they do over and over again. Maybe one trick is searching a room and giving a signal if there are any people in it. Maybe the trick is fetching medication from a specific spot in the house. Maybe it's calling 911 on a specially designed device. Maybe it's that deep pressure therapy I keep mentioning. But the point is this isn't a human, it's not your spouse or your friend or your therapist. It's an animal being trained to do a thing that has been broken down for them in a way an animal can understand.
It can help to think of the tricks as if/then statements. "IF I am engaging in self-harm THEN nudge my hand with your nose until I stop" for example. This breaks down your specific needs into something which could possibly be trained as well as gets out of the vague "Well I like dogs and I heard a Service Dog could be helpful so... should I get one?" thought process. And, again, it removes the bias of the cute factor from the equation. Are these tasks actually important enough and beneficial enough to be necessary regardless of how they get accomplished?
In my case the answer to the robot question was an immediate and emphatic yes. The tasks I could picture being done would be of benefit to me that it didn't matter who or what was doing them. I just needed something outside of myself to make them happen. If I could've snapped my fingers and made that robot appear right then and there I would've done it. That in my case the "robot" turned out to be a sweet and wonderful dog was a side benefit.
Speaking of which...
What Are The Other Benefits of a Psychiatric Service Dog?
First let me stress that I'm putting this in its own section because what I'm listing here does not meet the criteria for being defined as a Service Animal. These are things which are positive aspects of having a Service Animal but legally these things mean nothing. At best these might get an animal classified as an ESA.
But they are benefits of having an animal in your life so they are worth talking about when making the decision on whether a Psychiatric Service Dog might be of help to you.
For starters, they are cute. Legally this means nothing but in terms of your day to day life it does help to have this adorable creature who is utterly thrilled to see you in the morning. I've had times where I felt too miserable to get out of bed but having my dog bouncing around me and licking my face and making it clear that she thought today was going to be amazing helped me pull myself out from under the blankets.
Related to that, caring for them can be motivation. I might not be able to get the physical or emotional strength together to get out of bed for my own sake but I will do it to make sure my dog gets fed, gets exercise, and so on. I don't mind torturing myself (though obviously this is something my therapist and I are working on fixing) but I will not let an animal suffer. (Again, this goes back to how I have strong bonds with animals and thus this is a strong motivator for me.)
Likewise my agoraphobia makes it difficult for me to even open my front door if I don't have to, but since my dog needs to be taken out several times a day in order to potty I leave my home for her.
These are all small actions which are by no means cures, but they are things which keep me from backsliding into the worst of my day to day symptoms. Throw in the benefits that come with having a pet and, though none of this helps from a legal perspective, it's not nothing either.
Basically it's the second part of the robot question. First: are the tasks worth doing? Second: are they worth doing for you if they were done by an animal?
Again in my case the answer was yes.
Which means going to the next step, which is talking about the drawbacks.
What Are The Drawbacks Of Having a Psychiatric Service Dog?
Let's start with an easy one because it goes hand in hand with a benefit: A benefit is that you have to care for the dog which can provide motivation to do things like get out of bed when you might otherwise not be able to. A drawback is that you have to care for the dog. If this is something you can't guarantee you can get done, the dog is not for you.
Now it doesn't have to be that it's you caring for the dog. If you live with other people, such as family or a partner, it's fine if they pitch in to take care of things like feeding and walking. But the dog has to be fed, has to be walked, has to be loved, has to be played with, and so on. Like any other pet, this is a big responsibility. If you or the people who live with you can't make this happen, the answer to getting a dog of any kind is no.
Next, the dog comes with a cost. Dog food isn't free. Regular vet visits aren't free. And the thing to bear in mind here is that since we're talking about a Service Animal there is going to be an increased level of care that a regular pet might not need. Reason being if a regular pet is out of commission for a few days it's not wonderful but the worst that happens is that they're at the vet's for a bit then they curl up in your lap at home and get extra treats and love. But if your Service Animal is out of commission for a few days you don't get the benefit of them helping you.
You have to picture your Service Animal like a piece of medical equipment, no different from an oxygen tank or an insulin pump or a wheelchair. Yes, if a wheelchair breaks it could be sent in for repairs but what do you do in the meanwhile? If that's your only wheelchair you're screwed, right?
Same thing with your dog. If your dog is sick or injured IT DOES NOT WORK. It stays at the vet or stays home as needed but it doesn't go out into the world with you until it's feeling better.
Which means that in general you are going to want to err on the side of caution with your Service Dog far more than you would a regular pet. That means more frequent vet check-ins, and buying the highest quality food and supplies that you can afford. A tiny percentage of a difference in food might not matter as much when you're talking about a pet who does nothing but nap in sunny spots on the floor all day, but when you're talking about a dog who is not only working regularly but working to help your medical needs you don't want to take any chances.
On top of that, the dogs are expensive to get. Now the ADA says that people are allowed to train their own dog so yes, in theory you could pick a puppy out of a "free pets" box somewhere, take it home, and try to train it entirely by yourself to be a Service Dog with no cost to you other than the food, toy, and vet bills.
However, if you ask anybody in the Service Dog community they will tell you don't do this. The first thing you'll be told when you say "I want to train my own dog" is hire a trainer. That is because Service Dogs require highly specialized training in things people without experience would have no idea are even a thing. Did you know that the dog should know how to be comfortable walking from one type of surface onto another? While a bus exhaust goes off near it's face? And a child tries to grab its tail?
This is a fictionalized series but even so it is based on a real training school and shows some of the bare bone (no pun intended) basics of the types of things Service Dogs need to be trained for. This isn't even getting into actually doing the tasks to help mitigate disabilities. Could you train a dog to do even half of what they're showing there?
It's not for amateurs. So anticipate that even if you get your dog for free or are using an existing pet you will need to spend money on getting a professional trainer to help you. And the level of training means that you're looking at thousands of dollars in cost.
On top of that odds are EXTREMELY high your current dog can't do it. Even in training programs which work with breeders to get dogs with the highest genetic likelihood of being both intelligent and emotionally capable enough of working as Service Dogs, dogs fail. And this is, again, while working with breeders who have generations of dogs bred for the specific goal of being ideal Service Dogs. A dog that you got from somewhere who was not made for that purpose has a much higher likelihood of not being able to handle it.
Which isn't to say that you must get your dog from a breeder. My dog actually came from a shelter, because the training school I worked with worked with both breeders and with shelter dogs. But she was a shelter dog they picked as being a good candidate, and it's worth noting that while my dog managed to graduate her sister from the same litter did not. (Her sister is now a well trained and beloved pet, but she's not a working dog.)
Because of all this, the typical cost of acquiring a Psychiatric Service Dog can range from $20,000-30,000. Payment options vary depending on who you work with but in general you'll be asked for some kind of deposit up front and then for the rest to be paid by the time the dog is delivered to you. Typically dogs are trained for your specific needs so you will have some time to fundraise if you need it but still. Most people don't have this kind of money burning a hole in their pockets. You'll have to figure out how to get it somehow. (I did a GoFundMe, which is not uncommon for these kinds of things.)
On that note, it can take over a year to get the dog. Because mental health needs differ from person to person Psychiatric Service Dogs are often trained to the needs of the person. Between that and the time it takes to train the dog in the basics of manners and public behavior, you're looking at an average of 18 months from start to finish, and that's assuming the dog they earmark for you on day one actually passes the training program.
Because of that, when you are doing your research you'll want to find out how the program you work with handles the issue of a dog not being a good match. Some programs do it by pointing to a puppy out of a litter their chosen breeder just turned over and saying that's your dog, and if the dog washes out (which is the term used for dogs which can't do service work) then you have to wait for the next litter to come along and hope the dog they earmark for you in that one works out.
Other training programs will start training dogs in the universal basics - sit, stay, being housebroken, being out in public - and then wait until they are more grown to start matching them with handlers and training to their needs. This has a higher likelihood of providing a successful match when it comes but at the same time if they have five future handlers waiting and only 2 dogs manage to graduate, there's at least 3 people who are left waiting for the next group of dogs to come along (assuming there's even a good match between the two successful dogs and the waiting handlers at that time).
I know for me the waiting issue was a frustrating one. I wanted the benefit of my dog now. I was fortunate in that I was able to get my girl in about a year but we did go through a few candidates before she was matched to me. It was just fortunate that the place I used had enough dogs being trained at the time of my acceptance into the program that one not being a perfect match didn't mean waiting a whole year before another possible candidate cropped up.
Aside from the time and the cost, another potential drawback to having a Psychiatric Service Dog is they draw attention. If you have Social Anxiety Disorder the first thing anyone in the Service Dog community will tell you is to think long and hard about whether the dog is right for you. Because if being the center of attention makes you panic now, that will only get a thousand times worse once you're out in public with your dog. People will stare. People will ask questions. People will try to pet the dog without your permission. People will try to distract the dog. People who work in stores may challenge your right to bring the dog with you. And so on, and so on, and so on.
Frankly the actual advice given to people with social anxiety is don't get the dog. In general the possible benefits are far outweighed by the drawback that the dog is going to create every situation that makes your anxiety worse. It'd be like somebody with a peanut allergy keeping an open jar of Skippy with them at all times.
However, I will offer one counterpoint to this based on my own experience. I do have anxiety about being out in public and about people paying attention to me while I'm out in public. But in my case my dog helps with that because people pay attention to my dog. I'm invisible when she's with me. Yes, people do talk to me but it's to say things like "Oh my god she is SO CUTE!" Some may ask questions but even then the conversation is entirely about her. I can handle that. I can go into teacher mode and talk about her all the live long day because I'm not the one they're looking at.
So if you can't handle any attention then no, do not get the dog. But if you're like me and are okay if the attention is focused slightly lower and to the side of you, the dog can actually help.
On that topic, be prepared for repeated questions and challenges. I've been very fortunate in that so far I haven't gone anywhere where stores have given us a hassle. But I do get repeatedly asked about her, asked if I'm training her (because my disabilities are invisible so they assume I don't have them), asked why I have her, and so on.
My protip with this is to accept that this is life with a Service Dog and have replies at the ready which sound like answers but really aren't. For example:
Random person: "Are you training her?"
Me, brightly: "Oh no, she's fully trained. I'm not though! Ha ha!"
Random person: "Why do you need her?"
Me, again brightly: "I couldn't leave the house without her, she's great!"
And so on. Basically my firm yet positive tone takes advantage of social constructs to put them in a position where they're expected to smile back and act like I gave them an answer even though my words did nothing of the sort. This is often all I need to resume my shopping unimpeded. But again, I can handle this sort of interaction. You might not and that's perfectly valid, but keep it in mind when you debate if a Service Dog is right for you.
(Note: In these examples it assumes I'm talking to someone like a fellow customer. Store owners and the like can ask you about what your dog is trained to do and in which case the law says you must be specific. But in those cases you don't have to get into your diagnosis, just a quick list of some of your dog's tasks. So for instance you could say "Deep pressure therapy" but you don't have to say "Deep pressure therapy to pull me out of panic attacks which happen when I'm around the following list of triggers.")
Another drawback to be aware of is that other people's dogs are a potential danger. This is where all of those "therapy emotional service support" dogs really become a problem. For you as a human they're a nuisance because they run around in places they have no right to be. But when you have a Service Dog with you they are a potential threat to your dog's health and ability to work. Same for any other dog you might encounter who is untrained, unleashed, and in any way not under control.
With a dog who is a pet a random dog biting it could cause a trip to the vet and some stitches but otherwise wouldn't be a huge disruption. But as you know now, with a Service Dog that vet trip means you have lost your medical assistance for the duration of that healing. Worse, if your dog is spooked by the attack there's now the risk that your dog might wash out and never be able to work again.
It's not a guarantee. A spooked dog might be able to recover with training. But training's not cheap and it might not work.
So having a Service Dog with you means having to be extra vigilant about that possible danger. Which isn't a deal breaker, but if obsessive anxiety about things going wrong is one of your symptoms, this might make you worse instead of better.
One more potential drawback to consider is that your dog is a dog. By which I mean that it's an animal, and like any living creature it will have good days and bad days. Some days they'll be on task perfectly, be in a great mood, and do everything you could ever want like some magical creature out of a children's movie. Other days even the most well trained dog might get distracted by a squirrel, or be extra bored and only care about playing with toys when they should be working. You've got to be prepared to deal with the frustration and that some days are going to be harder for you both than others.
Finally, you must keep on top of your dog's training. Once your dog graduates that isn't the end of their education. You, their handler, need to work with them regularly to make sure they remember their tasks. Now depending on your needs you may have your dog tasking regularly enough that frequent refreshers aren't needed. But if there are some tasks which don't come up often, or tasks you want to make sure they can do in any circumstance, you'll need to schedule in time to work with them on a regular basis. And that's you, not a friend or family member. The dog needs to know how to work with you so it needs to practice with you. This might fall under the same heading as needing to feed the dog and thus be a perfect motivator, or it might be a responsibility that's too much for you to handle right now. Only you and your doctors can answer that question.
Conclusion: Should You Get A Psychiatric Service Dog?
As I've said, ultimately the answer to whether you should get a Psychiatric Service Dog is between you and your doctors. But hopefully now that you understand how to determine the possible benefits for your needs vs the drawbacks which everyone must deal with you are better able to start that discussion.
The process of getting a Service Dog of any kind is involved and too lengthy to be included along with all the other information for this article. Subscribe (if you haven't already) to stay updated on when that article will go live.
In the meanwhile I hope this helped. If you have any questions feel free to hit me up on social media. Thanks for reading!
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