The demand for emotional support animal (ESA) letters has increased significantly in recent years. More people now see the therapeutic benefits of having animal companions to help manage anxiety, depression, and trauma. As a mental health professional, you may receive more requests from clients asking for ESA documentation.

However, writing an ESA letter isn’t as straightforward as it might seem. Therapists may worry about potential risks to their license, legal liability, or overstepping clinical boundaries, especially when working outside of formal disability evaluations. The legal landscape around ESAs has also evolved, particularly in housing and travel contexts, leaving many clinicians unsure about what’s currently required and what’s within ethical scope.

In this guide, we focus on the key considerations for therapists writing ESA letters. We will look at the legal guidelines, clinical criteria, and best practices for creating effective, compliant documentation. You'll gain the tools and knowledge to support your clients while maintaining the highest standards of care.

What Is an Emotional Support Animal (ESA)?

An emotional support animal (ESA) is a companion animal that offers therapeutic benefits simply by being present. Unlike service animals, ESAs aren’t trained to perform specific tasks; instead, they provide comfort through their bond with a person living with a mental health condition. For many clients, the presence of an ESA can ease symptoms of depression, anxiety, PTSD, and other conditions that disrupt daily functioning.

Under the Fair Housing Act (FHA), individuals with disabilities are allowed to live with their ESAs even in housing that typically prohibits pets. However, legal protections have shifted in other areas. For example, in 2021, the U.S. Department of Transportation stopped requiring airlines to accommodate ESAs, though some carriers may still allow them voluntarily.

When clients request an ESA letter, they’re often seeking support for conditions that meaningfully affect their quality of life, such as depression, anxiety disorders, and PTSD. For the right person, the connection with an animal can be a powerful stabilizing force—a source of comfort, regulation, and unconditional companionship.

Therapist Responsibilities and Legal Considerations

As a mental health professional, it’s important to grasp the legal and ethical implications of writing ESA letters. Only licensed therapists, such as psychologists, psychiatrists, licensed clinical social workers, and professional counselors, qualify to provide this documentation. Engaging in this process without proper licensure or outside your scope of practice can lead to disciplinary action, including losing your license to practice.

You must establish an ongoing therapeutic relationship with the client before considering an ESA letter. Avoid one-time assessments or writing letters for individuals you have not thoroughly evaluated. This ensures you fully understand their mental health condition and can make an informed clinical judgment about the appropriateness of an ESA.

Be aware of the potential for misuse or pressure from clients seeking ESA letters. Some individuals may view ESAs as a way to get around pet restrictions rather than as a legitimate treatment for their mental health condition. Maintain professional boundaries and be prepared to deny requests that do not meet the clinical criteria for an ESA.

Stay informed about the legal implications and state-specific regulations surrounding ESAs. Laws and guidelines can vary by jurisdiction, so it's important to know the requirements in your area. Consult with professional organizations, such as the American Psychological Association or the National Association of Social Workers, for guidance on best practices and ethical considerations.

Avoid fraudulent certification sites and letter mills that offer ESA documentation without proper assessment or therapeutic involvement. These services can undermine the credibility of legitimate ESA letters and put your professional reputation at risk.

Assessing Clinical Appropriateness for an ESA

When a client requests an ESA letter, it's important to conduct a thorough clinical assessment to determine if an emotional support animal is a suitable intervention for their specific mental health needs. This evaluation process involves several key components:

• Identifying a qualifying mental health diagnosis: The first step is to confirm that the client has a psychiatric condition recognized by the DSM-5-TR or other clinical criteria. Common diagnoses that may benefit from an ESA include anxiety disorders, depression, PTSD, and phobias. The symptoms should cause significant distress or impairment in daily functioning.
• Evaluating the therapeutic benefit of the ESA: Next, assess whether the presence of the animal helps manage the client's psychiatric symptoms. This involves understanding how the ESA provides emotional support and comfort to the individual, as well as what may happen to the client’s symptoms if they were not able to live or travel with their ESA
• Assessing the animal's suitability: It's important to ensure that the animal has the appropriate temperament and behavior to provide emotional support without causing additional stress or harm. Consider factors such as the animal's size, breed, and training when evaluating its compatibility with the client's needs and living situation.
• Observing the client-animal interaction: Observe how the animal's presence affects the client's emotional state and functioning. Look for evidence of a positive, beneficial relationship between the client and their ESA.
• Conducting a comprehensive clinical interview: To gather a complete picture of the client's mental health history and current functioning, conduct a thorough clinical interview. This should cover their psychological, family, and medical background, as well as an assessment of their overall psychological well-being.
• Discussing the responsibilities of ESA ownership: Before recommending an ESA, have an open conversation with the client about the risks and responsibilities associated with owning an emotional support animal. This includes discussing the animal's care, training, and any potential limitations on housing or travel accommodations.

What to Include in an ESA Letter

To ensure your ESA letter meets legal requirements and maintains clinical credibility, it must include several important components. A well-crafted ESA letter not only supports your client's rights but also reflects your professional expertise and adherence to ethical standards.

• Clinician's information: Start the letter by clearly stating your full name, professional license type and number, and the state where you are licensed to practice. Include your contact information, such as phone number and email address, to facilitate verification if needed. Ensure the letter is printed on your official letterhead, which should display your practice address. Finally, sign the letter to authenticate its contents.
• Client's details: Identify your client by their full legal name and date of birth and confirm that they are under your ongoing care. State that the client has a mental health condition recognized in the DSM-5-TR, without disclosing the specific diagnosis to protect their privacy. This establishes the basis for recommending an ESA as part of their treatment plan.
• ESA recommendation and benefits: Clearly explain your recommendation for an emotional support animal as a therapeutic intervention for your client's mental health condition. Describe how the presence of the ESA helps alleviate symptoms and provides emotional comfort, enabling your client to better manage their daily life. Highlight the importance of the ESA in your client's housing situation, as this is a key factor in securing accommodations under the Fair Housing Act.
• Legal compliance and dates: Include a statement affirming that your ESA letter complies with relevant housing laws, such as the Fair Housing Act. You may also reference other applicable legal acts to emphasize the legal basis for ESA rights. Specify the issue date of the letter and include an expiration date, typically one year from the issue date, to ensure the document remains current.
• Professional appearance: Present the ESA letter on your official letterhead to convey authenticity and professionalism. Proofread the document carefully to eliminate any spelling or grammatical errors, as these can undermine the letter's credibility. Avoid using generic templates or boilerplate language; instead, tailor the content to your client's specific needs and circumstances.

Ethical Best Practices for Writing ESA Letters

As a mental health professional, it's important to maintain ethical standards when writing ESA letters. This means setting clear boundaries, conducting thorough assessments, and being transparent about what ESA accommodations entail. Here are some key best practices to follow:

• Establish expectations upfront: Before agreeing to write an ESA letter, discuss the process, requirements, and limitations with your client. Make it clear that an ESA letter does not guarantee public access rights like a service animal and that the client must meet specific clinical criteria to qualify.
• Document your assessment and rationale: Keep detailed records of your clinical evaluation, including the client's diagnosis, symptom severity, and how the ESA helps alleviate their condition. This documentation supports the validity of your recommendation and protects you in case of legal challenges.
• Consider alternative interventions: If an ESA is not clinically justified, explore other treatment options with your client. This may include therapy, medication, or other coping strategies that address their mental health needs. Be honest if an ESA is not the most appropriate intervention.
• Educate clients on ESA regulations: Inform your clients about the current laws and regulations surrounding ESAs, particularly the Fair Housing Act and the recent changes in air travel policies. Help them understand their rights and responsibilities as an ESA owner to prevent misuse or confusion.
• Maintain professional integrity: Avoid writing ESA letters solely to help clients bypass pet restrictions or fees without a legitimate clinical basis. This practice can undermine the credibility of ESA accommodations and negatively impact those with genuine needs. Prioritize your ethical obligations over client pressure.
• Stay informed on legal updates: Keep up with any changes in ESA laws and regulations, both nationally and in your state. This ensures that your recommendations align with current legal standards and protects you from potential liability.

Sample Emotional Support Animal Letter (Template)

To help you create a compliant and effective ESA letter, we've provided a template below that includes key components and language. Feel free to adjust this template to suit your specific client's needs and your professional practice.

[Your Name], [Your License], [Your Credentials]
[Practice Name or Letterhead]
[Address]
[Phone Number]
[Email Address]
[Date]

Address the letter to a specific individual when possible: Dear Mrs. Jane Smith,

If this information is unable to be obtained from the client, write: To Whom It May Concern,

I am a licensed [mental health profession] practicing in the state of [State]. I am writing this letter to confirm that my client, [Client's Full Name], is currently under my professional care for ongoing treatment of a mental health condition recognized in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). I have provided [Client's Full Name] with psychotherapy services from [Date of First Intake] to present. 

After conducting a thorough assessment and evaluation, I have determined that [Client's Honorific (Mr., Mrs., Ms, Mx) and Last Name]'s mental health condition significantly limits one or more major life activities. To help alleviate the symptoms associated with their condition and improve their daily functioning, I am recommending an emotional support animal, [The Type of Animal(s) the Client is Requesting and Their Name(s), as part of their comprehensive treatment plan.

The presence of an emotional support animal in [Client's First Name]'s home will provide therapeutic benefits and emotional comfort, helping to ease the symptoms of their mental health condition. Therefore, I respectfully request that you accommodate [Client's First Name]'s need for an emotional support animal in their dwelling, as provided under the Fair Housing Act.

If you have any questions or require further information, please feel free to contact me directly.

Sincerely,
[Your Signature]
[Your Full Name], [License Number]
[Title and Practice Name]

Remember, this template serves as a starting point. Tailor the content to your client's specific situation and your professional assessment. Ensure that you have established a valid therapeutic relationship with the client and have conducted a comprehensive evaluation before issuing an ESA letter.

Key Takeaways

Writing an ESA letter involves a careful balance between advocating for your client's needs and maintaining the highest standards of professional ethics. As a therapist, you are responsible for supporting your client's well-being while ensuring that your recommendations are clinically justified and legally compliant.

Consider an ESA letter as one part of a comprehensive treatment plan, rather than a standalone solution. An emotional support animal can offer valuable therapeutic benefits, but it should be combined with other evidence-based interventions, such as therapy, medication, or coping skills training.

When discussing ESA accommodations with your clients, encourage them to be aware of both their rights and responsibilities. This includes educating them about the specific protections provided by the Fair Housing Act, as well as the limitations of ESA access in public spaces. Highlight the importance of responsible pet ownership, including proper training, care, and consideration for others.

As mental health professionals, we need to stay informed about the changing landscape of ESA laws and regulations. This involves keeping up with changes at the federal, state, and local levels, as well as any updates to professional guidelines or best practices. Regularly reviewing the latest developments ensures that our ESA recommendations remain accurate, ethical, and legally sound.

The key to writing effective ESA letters lies in our commitment to professional integrity. By conducting thorough assessments, documenting our clinical rationale, and prioritizing our clients' genuine mental health needs, we can support their well-being while preserving the credibility of this important therapeutic intervention.