Emotional support animals (ESAs), and therapists writing ESA letters for clients, are frequent topics around here. After years of overuse, the FAA allowed airlines to ban ESAs from passenger cabins early this year, and every major domestic airline has done so. Now California has developed new rules for therapists wanting to write ESA letters, most commonly for clients who want an ESA in a housing situation that does not allow pets.
As a bit of a recap: Unlike service animals, ESAs do not require specialized training or certification, and cannot accompany their owners everywhere. ESAs have been primarily recognized in two legal contexts. The Air Carrier Access Act (prior to 2021) required airlines to allow ESAs in passenger cabins. And the Fair Housing Act requires landlords to allow ESAs even when pets are not typically allowed, so long as the ESA does not create an undue burden on the landlord. In each case, for someone to exercise this option, they needed an ESA letter from a mental health professional.
Mental health professionals appear to have been a bit too eager to meet that need. Several web sites sprung up, allowing anyone who wanted an ESA letter to be connected to a therapist in their state who would write such a letter with minimal actual interaction with the client. The presence of ESAs on flights skyrocketed, leading to frequent problems and complaints. Public skepticism of ESAs increased, as did industry concerns. Therapists in Colorado and California were disciplined by their licensing boards for issuing ESA letters without meaningfully assessing the clients first to determine whether an ESA was truly necessary. The bans on ESAs in passenger cabins on airplanes took effect in early 2021.
California’s new 2022 ESA rules
Now, California has adopted a new law that attempts to rein in some of those therapists still offering ESA letters to clients. As of January 1, 2022, any therapist in California writing a letter for a client’s emotional support dog must first:
- Be licensed where the client is located (in other words, they can’t provide ESA letters to clients outside of California unless they’re also licensed where the client is; that was one of the many issues in the previous California disciplinary action)
- Provide their license information, including number and issue date, in the letter
- Have a clinical relationship with the individual for at least 30 days before issuing the letter
- Complete a clinical evaluation of the individual regarding the need for an ESA
- Provide notice to the individual that misrepresenting the animal as a service animal is a crime
It’s really that third point — a 30-day clinical relationship — that is likely to be the strongest deterrent. For web sites that promise customers ESA letters within hours or days, that’s no longer a promise that California therapists can fulfill. There’s no minimum number of sessions that must occur in that time, but there must at least be a 30-day relationship.
Interestingly, the California law is written in such a way that it specifically references emotional support dogs rather than emotional support animals. So we might see a test case where a therapist provided a letter for, say, an emotional support cat without following those guidelines. But the new rules are good practices for any therapist, anywhere, considering writing an ESA letter. That’s especially true considering that subgroups of both the ACA and APA have issued statements advising that you shouldn’t write ESA letters at all unless you’re a specialist.
Almost eight years ago, I wrote about how 
Thousands of California mental health professionals working for Kaiser plan to begin an open-ended strike on June 11. They are protesting the company’s ongoing failure to staff up their mental health operations, resulting in Kaiser patients waiting several weeks between appointments. More than 700 stories of the human impacts of these wait times can be found at 
When the Public Service Loan Forgiveness program (PSLF) started in 2007, mental health professionals all over the country expressed optimism and relief. 
A little more than two years ago now, I left my position as an Associate Professor at Alliant International University in Los Angeles. Many people have asked me since then why I left full time academic work. The position was relatively well-paid, with good job security. I had good colleagues, many of whom are friends to this day. I had the closest thing to tenure that the university offered: A five-year rolling contract. And I was teaching and doing research, both of which I love.
A few years ago, I wrote about 
The first licensing board meeting that I attended was in Sacramento. I did not live locally, so I had to travel to attend the meeting. I can remember well that trip and all of the expectations that I had. Basically all I knew about the California Board of Behavioral Sciences (BBS) was what I had heard from professors while in my master’s program, which was that the BBS was some ultimate authority that was to be revered and respected.