Perspective on ESA’s from a Mental Health provider

[Alissa Engel]

I recently had an encounter with an ESA situation at one of my rental properties that prompted me to do some research. It was so bogus that I couldn’t look the other way. I am a mental health therapist in private practice.  Here’s what I learned, what I did, and the outcome.

Because I serve military and veterans mostly, I had several legitimate connections for service dogs that I reached out to.  These are legit organizations that provide a wonderful service. I also consulted my profession’s code of ethics. 

The first consideration when you are looking at an ESA “prescription” is the provider’s credentials. 

I am an LCPC.  Typically you will see some version of those letters (depending on the state) if someone is a licensed counselor.  LCSW is the other set of letters you will see if someone is a licensed social worker.  Both of these are Masters level clinical positions and can NEVER prescribe. Period.

You will also see PhD, which can mean several things.  I am a PhD in counseling which means that I am a doctor but I can not prescribe.  You may see PhD in a Psychologist.  Still can’t prescribe despite being a “doctor.” This is a grey area.  Some organizations argue that a Doctorate level clinician can prescribe an ESA.  I disagree, and I think it’s an ethical violation in the realm of “scope of practice” because of the wording of “prescribe” in the ESA rules. 

I tell my clients that they will need to get this “prescription” from their MD, PA, APRN, etc.   They are really the only clinicians that can prescribe.  Meaning they have a DEA number. 

The second thing to consider is the need for an on-going relationship.  Unfortunately, there are many online companies hiring clinicians to write these letters.  They only talk to the patient one time, give a diagnosis, write a letter, and make $300.  This is the equivalent of a MD giving someone a prescription that never expires, requires no follow-up, and has an infinite number of refills.  It’s insane and unethical.  It’s also pretty darn sketchy to diagnose something requiring an ESA in one session. 

So what did I do with my tenant?  I called the clinician who wrote her letter.  Tenant is in MT and the clinician was in NY, so I already knew what was most likely happening. She talked with her ONE time for 30 minutes.  Also, she is an LCSW (not a prescriber).  I pointed out the ethical flaws at play, and “gave her the opportunity to rectify.”  She immediately withdrew the letter.  She called me a few weeks later and thanked me.  She quit working for the company because of the unethical nature of the whole thing. 

Each license (LCPC, LCSW, psychologist) has their own code of ethics. They are National.  So, most of this should apply nationally.  Basically, an ESA letter should be from someone who can prescribe and who has an on-going relationship with your tenant. Hoping this is helpful.