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Prescribing Animals for Human Health: Above all, do no harm

Increasingly I encounter situations that involve the prescription of assistance or support animals for people with various health issues. There are two primary groups of prescribers: human healthcare professionals and self-prescribers, i.e., those who decide that one of these animals would benefit them or a loved one. This commentary considers the challenges and responsibilities facing those in the first group  although many of them are applicable to those in the second group too.

The majority of animals I encounter clinically were prescribed by human mental healthcare professionals for a growing array of behavioral and emotional disorders. These include depression, attention deficit/hyper-activity, autism spectrum disorder, and post-traumatic stress disorder and involve those of all ages. Less common are animals prescribed by human medical healthcare professionals for patients who have suffered heart attacks or chronic or debilitating diseases. Increasingly those in these groups also are apt to be taking antidepressants and opioid pain medications.

So far all of the animals involved have been dogs and the most common canine problem has been aggression. In all of these cases, problems arose because of human naiveté regarding normal canine behavior and the physiological as well symbolic nature of the human-animal bond. I offer the following based on these experiences to those prescribing these animals in hopes of  preventing the sometimes tragic consequences those people and their dogs experienced.

Determine that the patient/client truly wants an animal

Sometimes exhausted parents or other family caregivers will push for an assistance animal to relieve their own burden. Other times standard treatment protocols may reach a plateau and the animal is perceived as a way to move the patient/client beyond it. While understandable, a significant part of the animal’s healing potential results from the quality of the physiological and emotion bond that forms between the animal and that person. If that person has no desire to interact or is incapable of interacting with the animal in a quality manner, this will diminish and even eliminate any beneficial bond effect. If the recipient experiences negative emotions related to what the animal actually is or symbolizes to the person, both the person and the animal will suffer.

Ensure that the patient/client or some person is willing and able to reliably fulfill the animal’s physical and behavioral needs on a daily basis.

Ideally the presence of an animal will inspire patients/clients to muster the wherewithal to properly care for and exercise their dogs. However, this isn’t a given. People with certain disabilities may have good days and bad, and the latter may leave them with barely enough energy to address their own needs, let alone those of an animal. Insuring that someone in the household or a friend or animal caregiver will visit on a daily basis benefits the patient/client as well as the animal. Because of the nature of their work, these animals also need time to relax and enjoy themselves away from the patient/client every day to function at their best.

Clearly define what services you want the animal to provide for the client/patient before animal selection. Keep in mind that these behaviors will be over and above the animal being rock-solid in obedience.

A prevalent, if erroneous, human belief about dogs maintains that dogs live to please people; they somehow guess exactly what we want and provide it. However assistance and support dogs must be trained to perform specific tasks in addition to the aforementioned obedience.These skills must be so deeply embedded and automatic that the dog reliably and confidently can respond, even under chaotic conditions and independent of client/patient input if necessary.

Relative to obedience, members of the public and the law have no problems with well-behaved assistance or support animals in places where pets aren’t permitted. However, both rightly have a problem with unruly animals who pose a danger to others in those  environments. While disabled people with well-behaved and well-trained service, assistance, and support animals do have certain rights that should be fully protected, members of the general public as well as the growing population of disabled people sans such animals have rights too.

Ask the patient/client or that person’s caregivers to clearly define what services they want the animal to provide.

My experience has been that sometimes people expect these animals to perform mutually exclusive functions. For example, they want the dog to secure the physical space and keep them safe at the same time as they want the dog to sense and respond 100% to their emotional stress by licking, leaning against or otherwise focusing exclusively on comforting them. Or they want the animal to simultaneously comfort them and find the nearest exit in an unfamiliar building or park. It can’t be done.

Also please note that fearful people often want overt signs that their dogs will protect them, such as growling, barking, lunging at, and even biting. They don’t understand that such displays more often than not are those of a fearful dog not a confident one. This results in a frightened dog calling the shots for a frightened person. Admittedly these animals do take a protective view of their people. But it’s the dog, not the person, who determines the nature of the threat. The more fearful the dog, the lower the animal’s stimulus threshold; the lower the animal’s stimulus threshold, the more intolerant of change. Aside from such canine behavior alienating the patient/client from other people in general, these animals become a distinct liability should that person require emergency medical care for some reason.

Reconcile clinician and patient/client or patient/client-caregiver expectations

If this is possible, proceed to the next step. If it isn’t and the patient/client truly wants animal interaction, arrange for scheduled visits with certified therapy animals and their handlers.

Determine what kind of breeding, temperament, and training the animal will need to fulfill those expectations.

If you don’t know, do a literature search for articles regarding canine breeding, selection, and training for this kind of work. Talk to those engaged in this process or those who might steer you to those with such knowledge if they lack it themselves. If expectations include the animal having access to certain limited-access areas, check state and federal regulations that might pertain to this. Sometimes access is limited to animals that fulfill specific criteria. For example, psychiatric service dogs may be granted access whereas emotional assistance or support dogs may not.

Be actively involved in the selection process with the patient/client or that person’s caregiver.

Give the prescription of an animal for therapeutic purposes the same consideration you give to the prescription of a drug or other treatment. The answer to a patient/client’s question, “What kind of dog should I get?” shouldn’t be “Any kind you want” or "I'm sure Spot will work fine. He's a member of the family already."  Companion dogs have been bred to be companions, not caregivers or therapists. Successfully performing the latter functions on a daily basic requires a very special kind of animal. However, people who feel vulnerable may gravitate toward certain kinds of dogs for purely emotional reasons. Some choose those of the same breed they had in the past, often their childhoods, perhaps in hopes of recreating that special time. But just as they’re not the same people they were then, the purebred dog they get today may be nothing like the animal of the same breed they had as children years ago. Other times the belief that the childhood dog trained herself exists simply because they don’t remember how much time their parents spent training the dog.

Patients/clients also may succumb to breed stereotyping just like members of the general public. “All goldens are wonderful. Everyone knows that.” Uh, wrong.  Some are and often their wonderfulness in a particular situation results from a combination of breeding for good physical and mental health, selection based on the recipient’s lifestyle and needs, and that person’s ability to meet the animal’s needs in that environment. Lacking that, golden retrievers may succumb to behavioral problems and, sadly, more than their share of medical ones when placed in situations that demand more than they can give.

As mentioned previously, sometimes vulnerable people are drawn to dogs they perceive as protectors such as pit bulls or members of other breeds that carry a more macho charge. But like those “all positive” goldens, how therapeutic these animals are depends on proper breeding, selection, and attention given to the fulfillment of the animal’s behavioral as well as physical needs.

Yet another group of vulnerable people will select animals they perceive as more vulnerable than they are for some reason.This opens a Pandora’s box of potential problems associated with the rescue mentality, often fueled by a large dose of disneyfication that guarantees happy endings. Granted there are those with special needs who can conquer their own disabilities in the process of meeting those of a special needs animal. But even the most physically and emotionally capable people can find it difficult to summon the knowledge and commitment necessary to turn around a dog with problems. For those with disabilities, these animals could serve as sources of frustration and feelings of inadequacy instead of comfort and  empowerment. Instead of smoothing the way for these people to function in mainstream society, these animals alienate them from others. Is this the kind of experience you want for your patients or clients?  Is this the kind of experience you would want for yourself or a loved one?

Be prepared to wait.

Dogs capable of fulfilling the sometimes complex needs of those with disabilities are scarce and expensive because of all the time and effort needed to properly breed, select, and train these animals. This can create problems for clinicians whose patients or clients (or those people’s caregivers) want such an animal now. Impatience plus ignorance of normal canine behavior and what it takes to properly select, train, and properly care for such an animal may lead some to head to the local shelter or pet store, or to choose an animal on-line based on a picture and little information. Prescribers should do everything in their power to ensure this doesn't happen, if for no other reason than that they'll be blamed if the animal doesn't work out for some reason.

Include information about the dog in your client/patient history and update this every time you see that person.

Once you have helped place a dog that possesses the qualities necessary to meet your patient’s or client’s needs in a household with a support system that guarantees client/patient and animal well-being, make the animal’s information part of your professional files. And just as you request information about any benefits and negative side-effects of any drugs or other treatments you prescribed, request similar information about the animal. If the animal accompanies the person to the appointment, note the animal’s behavior and interaction with the patient/client and others in that environment as well as any changes in the patient/client him or herself. Sometimes even when you’ve done everything right, the animal may not work out for that some reason. Or perhaps at some point the patient's or client's ability to interact with other people in complex environments improves enough that the person no longer feels the need for the dog. If this occurs, be prepared to help that person find a suitable home for the animal.

Be prepared for animal illness, injury, death and any negative effects that may interfere with or terminate the dog’s ability to meet the patient/client’s needs.

In the long-established service dog realm, this eventuality is addressed when animals are retired after a certain age to live out the rest of their lives as pets and replaced with other working animals. At this time though, there appears to be no comparable system in place for mental health and emotional assistance and support animals. The loss of an animal with whom one has a strong bond due to trauma or illness can be difficult for anyone. For those who have grown dependent on the animal for their own emotional well-being, such a loss can be devastating and precipitate a physical or mental health crises. At such times of animal-related transition, they’ll need the support of their healthcare providers more than ever.

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The above mostly likely raises points that some prescribers might prefer to deny exist, let alone address. But unlike drugs with negative side-effects that don’t negatively affect other people or animals with whom the patient has contact, poorly bred, selected or trained assistance or support dogs who resort to aggression and other problem behaviors when they become overwhelmed can and do. And when they do, it not only affects those individuals involved, it undermines the credibility of every quality animal doing quality work for people in need.

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