Not Just Emotional Support: Emotional Support Animals (ESAs) Help Reduce Loneliness for Individuals with Serious Mental Illness

Background and Purpose: Loneliness is associated with increased risk of physical illnesses, reduced lifespan, and exacerbation of mental disorder symptoms. While animal companionship is widely anecdotally recognized as reducing loneliness and living with a mental or physical disability is a risk factor for loneliness, there is no research examining how Emotional Support Animals (ESAs) – companion animals identified as therapeutically necessary for individuals with a disability via written clinician statements – may impact loneliness. This paper begins to address this gap through analyzing retrospective accounts of individuals with a serious mental illness (SMI) after acquiring and living with ESAs for 12 months. This qualitative analysis is part of a larger study in which findings showed statistically significant reductions in UCLA Loneliness Scale Scores after acquiring ESAs.

Methods: Eleven semi-structured interviews were conducted with adults (ages 40 to 74) who met the definition of SMI; specific primary diagnoses included Major Depressive Disorder, Bipolar Disorder, and Schizoaffective Disorder. The sample is predominantly cisgender female (75% cisgender female; 25% cisgender male), White (50% White; 33% Black/African American; 17% Multi-Racial), and lower socio-economic status (all met criteria for Medicaid and received mental health disability-related income support). Participants were recruited from the Hope and Recovery Pet (HARP) Program, which places ESAs with individuals with SPMI who have low income, live alone, and have been identified by their referring healthcare provider as at risk of social isolation. Twelve months after the participants had adopted their respective ESAs, individual interviews were conducted with participants to elicit their experiences of living with their ESAs, and to identify to what extent ESAs had impacted their well-being. Interviews were transcribed verbatim and coded thematically using Atlas.ti qualitative software. Codes included both a priori themes from the human-animal interaction literature related to social benefits and inductively identified themes that emerged through open coding. Analysis was guided by the process-focused principles of Charmaz’s delineation of grounded theory.

Findings: Data analysis revealed that all participants experienced reduced loneliness after acquiring ESAs; participants explicitly linked reduced loneliness to the presence of and interactions with their respective ESAs. Data suggested participants experienced both direct (the companionship of the ESA) and indirect (the ESA providing connection to humans) social benefits related to their relationships with their ESAs, which were associated with reduced loneliness. Several interrelated sub-processes emerged related to direct social benefits: occupying a special social role (e.g., “my baby”); “having someone”; “being a good listener”; “playing together”; “being there”/having company; and “snuggling”/physical contact. In addition to alleviating loneliness, participants also attributed their perceived improvements in mental health to their respective ESAs.

Conclusion and Implications: Under the Fair Housing Act, the presence of an ESA is recognized as a housing accommodation, however, there is ongoing confusion among clinicians regarding whether and how to verify client need of ESAs. Findings help explain how ESAs alleviate loneliness experienced by individuals with SMI, and inform efforts to educate clinicians on ESA verification, supporting improved access to ESAs for those with legitimate need.