This post is a comprehensive guide to some of the considerations and protocols necessary to successfully integrate a Service Dog into an inpatient psychiatric stay. There is also a downloadable template for administrators and mental health professionals to utilize to develop workable Service Dog protocols and guidelines for their facilities.
This guide is written for:
There are many points to consider when preparing to bring a Service Dog on unit, especially for locked units. With some foresight, planning, and proper training, the admissions process can be smoothly handled. For behavioral health facilities and psychiatric units, developing a comprehensive Service Dog plan and list of protocols should be done before they’re necessary so that admission can be as stress-free as possible for everyone involved — staff, admin, patient, dog, and the other people on unit. You can download a Service Dog protocol template that can be utilized to develop your facility’s protocol here.
When it comes to the laws regulating Service Dogs and integration into behavioral health facilities, things aren’t exactly cut and dry. Not only are the laws not exactly clear, but many psychiatric treatment facilities don’t have clear guidelines in place. That makes them more apt to simply deny access, because they don’t know how to best address the matter. However, there are ways to address the common (and legitimate) concerns that could allow a facility to legally deny your Service Dog access. Those solutions and compromises will be detailed later.
Federal Laws About Service Dog Access to Hospitals
The most important legal point regarding admitting a patient with a Service Animal is found in the Americans with Disabilities Act of 2010 (ADA). The ADA is a legal federal enactment that applies to all places of public accommodation and commercial facilities. This federal law specifically includes hospitals and medical treatment or care facilities. In a nutshell, the ADA Service Dog access laws require all places of public accommodation to allow access for individuals partnered with a Service Animal. Here’s a more thorough breakdown of federal Service Dog law, and here’s a more thorough breakdown of the law as it specifically pertains to hospitals.
Hospitals are specifically mentioned in the ADA list of public accommodations required to allow Service Animals. However, hospitals are only required to allow Service Dogs in places where members of the general public are allowed. These areas include the emergency room, general patient rooms, and common areas like the lobby, cafeteria, and gift shop.
Service Dogs do NOT have to be admitted to sterile areas or to areas where the public can’t access, like radiology, cardiac care units, the N/ICU, or labs. Having a Service Dog is not a magic ticket to anywhere someone wishes to go. Service Dog handlers have to follow the same rules other members of public abide by.
Hospitals may not exclude Service Animals from publically accessible areas on the basis of potential allergies to canine dander, fears or phobias, or any reason that isn’t:
Summed up, that portion of the law requires 3 things before a Service Dog can retain access to the hospital. First, all admitted Service Dogs must be under control. This means they are well-behaved, responsive to the handler, not a nuisance, and not a danger to anyone present. Second, the Service Dog cannot alter the way the hospital provides services. The presence of a working Service Dog cannot fundamentally change the way the hospital does things. Third, the dog must be housetrained. If any of the above 3 requirements aren’t met, the hospital can legally ask you to remove your dog. If they do so, they must allow you to continue to seek services without your canine partner.
The law requires the handler to care for the Service Dog at all times, including feeding, grooming, exercising, and toileting. Staff members can never be required to care for the Service Dog. If the handler is not capable of caring for the dog, then the handler can have someone else (friend or family member) come to care for the dog.
It’s important to note that the hospital is under no legal obligation to allow the friend or family member special access to restricted areas of the hospital in order to care for a patient’s Service Animal. If the handler is not capable (because of illness or something else) of making the decision to have someone else come care for the dog, the hospital can then board the Service Animal at a trusted facility. However, they must first allow the dog’s partner the opportunity to make other arrangements.
Service Dogs in Hospitals Are a “Reasonable Accommodation”
Having a Service Animal in a hospital, particularly as a patient, is a “reasonable accommodation” and not a right. If a legitimate medical or safety reason to exclude the Service Dog exists, then the Service Dog can be excluded, period. This includes psychiatric units and behavioral health facilities, which are *not* generally areas of the hospital that members of the public may access.
It’s best to be prepared and to know how to address concerns that may come up. This is particularly true if the facility, unit, or hospital does not already have a written Service Dog policy. When requesting access for your Service Animal, being polite, responsive, and prepared will go much further than being combative, defensive, and loudly proclaiming your “rights.”
The most important legal points regarding inpatient psychiatric stays and Service Dogs include:
Psychiatric units and behavioral health facilities are designed to be a safe haven. This often means that access to certain items or types of items are restricted. Movement, activities, and access to places outside of the unit are also usually limited in an acute inpatient setting. Residential, step down, and less intensive programs often permit varying degrees of freedom. That can make admission with a Service Animal a bit easier.
Since freedom is often limited and access to various items commonly utilized in the care of a Service Dog may not be allowed, there are several very important particulars to consider when developing Service Dog protocol and policies (for facilities), and/or while preparing for an admission with your Service Dog by your side (patients).
Partnership with a Service Dog encompasses several realms of care. Each is affected, even if only tangentially, by inpatient psychiatric care. Those realms include, but aren’t necessarily limited to:
As noted, each of these points will need to be considered and addressed. Healthcare facilities should consider adding a section for each to their formal Service Dog protocol or policy. Additionally, the specifics concerning each realm should be clearly laid out and defined. There’s a sample protocol available for download (Inpatient Psychiatric Service Dog Protocol Template) that can be used as a template to help build a comprehensive protocol for your facility. Having a formal set of requirements cuts down on conflict, which allows for smoother communication between all parties.
When it comes to Service Dog equipment and gear, things can vary widely. Different dogs utilize different items and combinations of items, depending on their job. However, common gear includes vests, harnesses, leashes, collars, head halters, and bandanas. A common rule on psychiatric units and in behavioral health facilities says that no rope-like items are to be possessed by patients. Carefully consider your dog’s ability to work off-leash. If your dog cannot, it’s possible the facility could deny access since possession of the leash would fundamentally alter the unit’s safety rules/requirements.
A judge ruled in New York that a Service Dog staying on an inpatient psychiatric unit would not be required to give up their harness or vest. Other gear, though, like collars or head halters, could potentially fall under the mandatory safety rules. Making requirements clear for all parties is vital.
Just like all dogs, Service Dogs need to eat daily. In many facilities, patients are not allowed to have direct possession of food outside of facility-provided snacks and meals, and especially not in their room. Typically, everything brought in by a patient is thoroughly searched by staff so safety can be ensured. This will most likely include a Service Dog’s gear, food, and basic care supplies.
An easy way to ensure your dog’s food isn’t a problem is pack it so it’s easily visible and doesn’t require any extra work on the part of the facility. Measure out each day’s food into individual Ziplock (or similar) baggies, with one meal to a baggie. Add any non-liquid supplements into the baggie with the food before sealing the bag. Neatly place the baggies into a clear plastic container with a lid. Pack a few extra meals, just in case. Your goal here is to make feeding your dog as much of a simple, easy, single-step process as possible.
Tape a piece of paper, information side down to protect privacy, to the underside of the lid. It should clarify and detail the following:
The entire container, which should be able to be securely closed, can stay with staff.
A baggie of food can be easily handed out for meals with morning, afternoon, or evening meds. If required by the facility, the food might have to be offered in a supervised area like the day room.
Make sure to find out what the exact requirements are concerning feeding your dog. Some places will let you use the food to train and reinforce behaviors. Others will want you to place it directly in a bowl and not touch it again. After your dog eats, return the empty plastic baggie and bowl to staff, if required.
Utilizing this system means no one has to
The dog’s food bowl can also stay behind the counter, if necessary. Wash the bowl out at the sink after each meal. Food particles plus moisture can be a breeding ground for bacteria, so wash thoroughly! Consider using a soft-sided or rubber bowl instead of metal or hard plastic, even if the facility doesn’t require it. Metal/plastic bowls may be utilized as a projectile, and may thus be deemed a hazard.
In most facilities and psychiatric hospitals, patients are allowed free access to water throughout the day. If that’s the case, having a bowl of water out for your Service Dog shouldn’t present a problem. Again, consider using soft rubber or collapsable bowls for safety’s sake. On some units, having a bowl of water out all the time isn’t allowed. Instead, water can be given during regularly scheduled unit mealtimes or during the Service Dog’s mealtimes.
What goes in must come out! Toileting a Service Dog is a huge part of figuring out how to integrate dogs into an inpatient psychiatric stay. Most dogs need to go anywhere from 3 to 10 times a day. Many Service Dogs can easily manage if offered opportunities to relieve themselves 3 to 5 times a day. There are many issues surrounding the toileting of a Service Animal, including:
Of course, all of this presumes that your Service Animal is impeccably house trained and has been accident-free for a long time. They need to “hold it” until provided with an opportunity to go, even if opportunities are limited. If your Service Dog is not reliably house trained, then they should not be brought with you to the hospital. Lack of house training is one of the few legal reasons why a Service Dog can be excluded. Before beginning the process of gaining access to a behavioral health facility with your dog, you need to have complete faith in their housetraining. If you don’t completely trust your dog, it’ll just be more stressful for you and all involved. This is a situation where no one needs additional stress, particularly not you, the patient.
The next thing to determine is if the facility, hospital, or unit provides opportunities for patients to go outdoors. Many do, but just as many do not. If they do, then toileting your dog can be easily built into the routine. Some programs allow patients a brief time outdoors after meals or after group therapy times. There’s a lot of value in some fresh air, exercise, and sunlight! If multiple outside opportunities aren’t provided on the schedule, it’s ok! Even one or two scheduled trips outdoors a day makes things less complicated.
If you cannot get access to the outdoors as part of the normal schedule, there are some other possible solutions. First, request supervised trips outdoors just long enough for your Service Dog to do their business. This request may not be granted, as it requires staff to go out of their way to accommodate your dog. However, many places will accept this compromise, if they’re able to do so easily and have the staff to spare. If they won’t permit this in the beginning, they may allow it after a few days. You will likely need to have demonstrated the ability to remain safe. It never hurts to ask, though, so don’t be shy.
Some facilities are comfortable with a friend or family toileting the dog so that neither staff nor patient need to leave the unit, if the patient arranges it and the routine doesn’t disrupt the daily activities. Some facilities will offer to let a staff member take the Service Animal outdoors, although it is very, very important to understand that the program is not required to do this, nor are they required to allow others access to the unit to help care for the dog.
One of the final options involves utilizing pads. This necessitates that your dog be willing to use a pad, that pads of the proper size are available, and that your dog be trained to toilet on command. If you have a large breed dog, consider purchasing human bed pads since they are much larger, instead of dog piddle pads. If there is a possibility that you will be hospitalized, then consider teaching your dog to use a pad well before it might become a necessity. It’s a very useful skill for Service Animals to possess. It could be utilized not only in the hospital, but also during bad weather, periods of sickness, or while traveling. You could also consider toilet training your partner, which is a solution that cuts out almost all of the hassle and cleanup. Toilet training is more commonly done with cats, but it is absolutely possible with dogs!
If you offer pads as a solution, then you also need to discuss how you will clean up and dispose of the waste, as this task falls solely to the handler of the Service Dog. It is a simple enough matter to wrap the pad around the waste and dispose of it in an appropriate receptacle. If allowed, you can also have a supply of larger plastic bags brought in and stored with your dog’s food or behind the nurse’s counter, that you can request when needed so that the soiled pad can be wrapped and sealed to control odor before disposing of it.
Regardless of the method chosen for toileting your dog, you must be prepared to clean up after your Service Dog and to properly dispose of the waste. You will likely not be allowed to keep plastic bags with you or in your room, as they’re a suffocation hazard. You will need to pick one up from the appropriate staff member as needed, and you will probably have to utilize it as intended while supervised. Once you’ve completed the clean up, dispose of it in a designated waste receptacle before returning to the unit or to your regular activities.
The easiest way to pack bags is to include a box of Ziplock (or similar) baggies inside the clear container in which your dog’s food is packed. You can then request a baggie as required, or per whatever guidelines the facility protocols mandate. Quart sized baggies are best for disposal of outdoor waste, and gallon sized baggies or hole-free plastic shopping bags (depending on the size of your dog) are best for the disposal of used pads.
It’s vital that your Service Dog be extremely solid on their basic obedience, both on and off leash. They must possess solid, reliable public access skills and their manners need to be above reproach. Inpatient psychiatric treatment is not a place for Service Dogs who are still refining their skills, or for dogs who require constant management. They should be able to relax and remain with you without needing much prompting, even under heavy distraction.
It’s very likely that you may not be able to have your dog’s leash or collar for safety reasons, so it’s important that your Service Dog be able to heel, hold a stay, settle well, do an “under,” perform their tasks, and ignore distractions, including food and/or curious, highly interactive people, all while off leash. They should be able to obey and perform in a crowd, around food, and while other people are doing their own thing, regardless of whether the people are standing, at a table, sitting, on the floor, quiet, screaming, etc.
In short, they need impeccable automatic impulse control. You cannot predict the behavior of others on unit. In order to be the most comfortable, your dog should have a history of not being phased by anything, regardless of how unpredictable or “weird” something, someone, or a situation may seem. Other patients may not respect Service Dog etiquette, so it’s important that your dog be able to ignore other people trying to entice them over or get their attention. They should also be able to ignore the infamous “drive by petting” or being touched as they pass.
Screaming, meltdowns, panic and anxiety attacks, displays of aggression, and tense situations all occur regularly in acute inpatient settings. While not as common as it once was, physical restraint is still utilized when necessary to ensure the safety of a patient or the others on the unit. If someone requires restraint, it can be unsettling, stressful, and even scary, not only for the person being restrained, but also for any observers. Your dog should not become keyed up or overexcited by raised voices, thrashing around, rocking, pacing, agitation, or commotion.
Your partner should automatically follow you when you move. They should settle close to you during groups, therapy sessions, recreation, or when you go to bed, without wandering off or engaging with others. An easy way to train for these circumstances, especially the automatic off-leash behaviors, are with the so-called “naked dog” training games, and with impulse control games. Sue Ailsby’s Training Levels are a great resource.
Reward handler proximity. Reward focus. Reward responsiveness. Don’t leave things to chance, as our dogs don’t rise to our expectations. They fall to the level of their training. Thoroughly prepare your partner ahead of time for any potential future hospital stays. Enjoy the training along the way, too!
Your dog’s skills need to be polished and proofed. Your Service Dog being on-unit with you is meant to reduce your stress, not add to it. You don’t want to be required to actively train or manage your dog, especially not because of ill behavior. Additionally, your dog should be unobtrusive and inoffensive. Your dog should not vocalize. Your dog should not be timid, reactive, aggressive, or fearful. Your dog should not jump, steal, ignore you, or otherwise showcase bad manners. Your dog should not be high-strung, anxious, wound, jittery, and/or unable to relax.
Your Service Dog will need to be able to spend hours or entire days doing nothing except hanging out and performing tasks for you as needed. A good way to provide mental stimulation to your dog while on unit is to perform tricks or cue differentiation and thinking games. You may not be able to reward your dog outside of verbal praise and petting. As long as your Service Dog has a solid training foundation and is familiar with the behaviors, that’s fine. We encourage all Service Dog handlers to teach their dog tricks for bonding purposes, skill development, and mental stimulation. There’s no reason to not start now!
When it comes to having animals in hospitals, hygiene is an important consideration. The Society for Healthcare Epidemiology of America released new guidelines on having animals in hospitals. It has more or less summated that well-cared-for dogs do not pose a huge risk of transmitting disease or devastating bacteria. However, they do note that the hospital’s cleaning staff should be made aware of the presence of the dog, and that appropriate precautions be taken.
Handlers should be prepared to wash and sanitize their hands regularly. They may be asked to provide wipes for their Service Dog’s feet, to be utilized before and after the dog goes outside. Boots may be requested by the facility, which may only be worn while the dog is inside. Boots should be considered for your partner’s comfort, anyways, as many dogs aren’t used to working solely on slippery tile for days at a time.
If requested, Service Dog handlers should provide copies of:
All of this information should be copied and kept neatly in a folder, just in case it’s ever needed. Generally, places of public accommodation can’t ask for this type of documentation. However, since Service Dogs may be excluded from non-public areas of the hospital, it’s a good idea to be prepared to present healthcare documentation.
Many Service Dogs require regular grooming, including brushing, ear care, paw care, or teeth care. You’ll need to discuss how you can access the materials necessary to care for your dog. Many facilities will hand your dog’s personal care items out to you when they provide your personal care products of a morning or evening. Some places may require you to be supervised while using them, especially if the combs or brushes contain metal. If you can’t have access to grooming supplies, ask if a visitor can perform the chores for you.
Using baby shampoo (regularly provided by behavioral health facilities) and allowing your partner to shower with you is an easy way to keep them clean and smelling fresh. An alternative, if allowed, would be to use something like a waterless shampoo to keep their coat clean and deodorized. Just request that whatever you use for your dog’s skin and coat be handed out with your own hygiene products. Placing the product in a smaller bottle might make facilities more inclined to accept it. Having the product in its original container might provoke fewer questions. Just ask the facility what they would be most comfortable doing. You may be required to provide unopened bottles so that the program can be certain nothing was added.
As always, prepare the products in a way that makes them very simple to hand out and use. Consider pre-moistening cotton pads with ear solution and sealing them in a baggie for later use. Put your dog’s toothbrush and a small container of their toothpaste in a baggie together. Consider skipping paw care for awhile, as it’s unlikely you’ll be allowed access to clippers or a dremel. If you can’t, make arrangements for a way your Service Animal can have their paw care safely handled.
Getting exercise for a Service Dog admitted to a psychiatric care facility can be difficult. If the regular schedule of events includes time outdoors, then running around or a few solid minutes of walking remain possibilities. Otherwise, you may be left to walk a few laps around the unit. Playing mental stimulation games is always a great possibility, too.
Most of this can be boiled down to “communicate clearly,” “compromise,” and “find solutions.” There are ways to make sure everyone remains safe — patient, dog, others on unit, staff — while also ensuring that a patient partnered with a Service Dog can remain with their dog. Not separating dog and person can be particularly important during trying times like psychiatric hospitalizations. There’s enough going on without subjecting someone to the stress of having to fight for access to a proven treatment modality.
Facilities should know how they’re going to handle a Service Dog admission before one comes along, so the entire situation is as stress-free and smooth as possible. When you’ve got a patient sitting across from you with their dog is NOT the time to figure out how this is all going to work. It’s important to keep in mind that the facility and staff are not required to do anything with the dog. It’s all on the patient. The dog will not add to staff member’s work loads.
Likewise, patients should work with their dog from the beginning on polishing and solidifying skills. That has nothing to do with being admitted for an inpatient psychiatric stay and everything to do with being a good Service Dog team. That being said, you should have faith in your dog’s skills before you start the admissions process.