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Commentary: 'prescribing' pets for patients with mental illness.

Rsoughly 78 million, or 62% of households in the United tates, have a pet, according to the American Pet Products Association. It is estimated that Americans will spend $55.53 billion on their pets in the year 2013 alone.

Over the last decade, the mental health profession has been placing an increased emphasis on the potential healing benefits of animal companionship. In light of these trends, animal companionship can play an important role in our work with patients with mental illness and their families.

Froma Walsh, Ph.D., has examined both existing research and the history of animal companionship in a two-part review (Fam. Process 2009;48:462-80 and Pam. Process 2009;48:481-99). Dr. Walsh found that animals can assist in the family education of authority, boundaries, and communication. They also can become the subject of affection and attachment that provide the family with a common bond, according to Dr. Walsh, codirector and cofounder of the Chicago Center for Family Health, and the Mose and Sylvia Firestone Professor Emerita in the school of social service administration and department of psychiatry at the University of Chicago.

In addition, research has shown that a relationship exists between pets and improved outcomes within serious mental health diagnoses. For example, researchers at the New York State Psychiatric Institute found that pets provide outlets for empathy, connection, self-efficacy, and support for adults with serious illness. Their conclusion was based on surveys from 177 health maintenance organization members who had participated in the Study of Transitions and Recovery Strategies study (Am. J. Orthopsychiatry 2009;79:430-6). Interestingly, participants who owned pets were found to have a greater avoidance of isolating behaviors.

We need to be aware of potential resources for using animals that can be tapped to help our patients. Within the canine species, three types of therapeutic dogs are shown to provide benefits to psychiatric patients: Emotional Support Dogs (ESDs), Mental Healthy/Psychiatric Service Dogs, and Therapy Dogs.

An ESD is a therapeutic dog that can be used to assist an elderly person or an individual with disabilities. The primary purpose of an ESD is to provide the owner with affection, companionship, and improved motivation to fulfill important tasks of daily living, such as getting a basic amount of exercise and going outside. ESDs do not qualify as service dogs under the Americans with Disabilities Act, but they are covered under the Fair Housing Amendment Act and the Amended Air Carrier Access Act. Therefore, ESDs can live in certain types of housing that have "no pet rules" and must be allowed to sit with their owners in the cabin of an aircraft.

Mental Health/Psychiatric Service Dogs undergo rigorous and specialized training in basic and advanced obedience, public access, and task performance. These dogs are found to be especially effective in the lives of people who suffer from anxiety disorders, including posttraumatic stress disorder. They can perform such tasks as providing a buffer for the handler in crowded areas and helping reduce hypervigilance on the part of their owners. They also can be trained to remind owners to take medication.

Therapy Dogs are available to provide affection and comfort for people in nursing homes, hospitals, hospices, and community centers. To be registered as a therapy dog or cat, the pet must be very social and enjoy human companionship. Animals and their handlers must be registered and pass a certification exam.

The National Alliance on Mental Illness provides free, ongoing groups that offer peer support and therapeutic interaction with professionally trained pet therapy dogs. In our clinical experience, we have found that patients gain a greater sense of independence, self-worth, and purpose not only by interacting with therapy dogs but also by engaging in this type of volunteer work with their own pets.

Another useful resource, Puppies Behind Bars, helps inmates train service dogs for veterans with PTSD. Paws and Stripes provides veterans who suffer from PTSD with a shelter dog and interactive training at no cost. Heeling Allies privately trains mental health service dogs and ESDs to enrich the lives of people living with psychological, neurologic, and developmental impairments.

Given the shifting focus of psychiatry to a more comprehensive recovery model, evidence that animals can function not only as social companions, but also as therapy pets is gaining attention. With further research, we might be able to determine a mental health need presented by a patient and subsequently "prescribe" the kind of animal that would be best suited to "treat" the need.

In the meantime, clinicians should keep in mind the benefits of pet companionship. Discussions involving the meaning of pets in patients' lives might increase the therapeutic alliance and make patients feel more connected, understood, and engaged in their treatment.


Caption: DR. ASCHER

Caption: Service dogs can be very effective for patients with anxiety disorders.



Dr. Wittenauer is a first-year child and adolescent psychiatry fellow at Cambridge Health Alliance/Harvard Medical School, Cambridge, Mass. Dr. Ascher is a postdoctoral fellow in addiction psychiatry at the University of Pennsylvania Perelman School of Medicine, Philadelphia. Scan the QR code to read more commentaries at
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Title Annotation:OPINION
Author:Wittenauer, Justine; Ascher, Michael
Publication:Clinical Psychiatry News
Date:Dec 1, 2013
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