This is an incomplete (and highly unorganized) master post that I will update and re-publish as I go. The reason for posting this incomplete work-in-progress is because this information can’t be found elsewhere online. I am working on a table of contents for this post to make it easier to navigate. Feel free to comment questions or suggestions for this post. You can also message me your questions on Facebook via http://m.me/abittachy for a quicker reply.
So you wanna bring your service dog to rehab? I have now been to two IOPs, two Day programs (PHP), and two Residential treatment centers with my service dog. It is an undertaking not for the faint of heart but was absolutely necessary for me to do in order to access treatment at all.
In order to bring your service dog to treatment, you will (more often than not) need to possess good advocacy skills. This is a tall order for most people seeking treatment because it may be a skill they do not already possess. If you believe you will need help advocating for your needs as a service dog handler, please reach out to a friend or community member (from the service dog community) who would be willing to help you do this.
This post is written from the perspective of an American and all information is given through the lens of the Americans with Disabilities Act.
Schedules, Stress, and Service Dogs In Training:
If you have a service dog in-training, now is not the time to bring your dog to treatment with you. While some states do protect service dogs in-training and offer them the same rights as fully trained service dogs, the likelihood of that dog being ready to handle working from dawn until dusk is highly unlikely. The reality for my service dog working in the inpatient and residential treatment environment was a life of being on-duty from 7am to 10pm at night. Sometimes earlier. My first and second admissions had required vitals and weights done at 3:30am every day. For this, I left my service dog in my room to allow her to sleep. Other handlers may not be able to do this due to the nature of their disability or due to hospital expectations of their dog being with them at all times.
It is not fair to force a service dog in-training to comply with such a rigorous work schedule. Dogs that are still training need shorter “shifts”, regardless of age. Puppies and adolescent dogs especially need shorter shifts as well as ample play time to regulate themselves (and possibly more potty breaks).
The typical rehab schedule is vitals, breakfast, meds, groups, groups, more groups, lunch, meds, groups, therapy, groups, break, dinner, meds, groups, break, meds, bed. This is a lot on both the handler and the dog. For the dog, it is a lot of laying down and staying quiet. The schedule is much more rigorous than most college schedules, even. On top of this, there may be air travel or trains involved in travelling to treatment and the entire experience as a whole is very disruptive and stressful on both dog and handler (especially an inexperienced dog).
Depending on where you go, there may be a lot of down time or there may be very little to none. You may have access to your room during the day, or you might not. During my first admission, I had ample access to my bedroom except for during groups or after meals. During my second admission, I didn’t access to my bedroom between breakfast and 4pm because I was on supervised “day room” (which means I couldn’t leave the day room without permission) but I had ample access right before dinner and after the last group of the evening. My third admission I had almost no access to my room between breakfast and 9:30pm.
Having access to my bedroom during the first two admissions allowed me to access items for my service dog throughout the day, rest with, and play with my service dog off-leash in my bedroom. Not having this kind of flexibility during my third admission was more wearing on my service dog because she was “on duty” from breakfast until bedtime. However, there was the occasional 15 minute block of down time during that third admission where I would play with my dog in the day room. This was not professional of me and is it not required that any facility allow this. However, the staff supervising the day room were excellent and understanding and allowed it. I would keep a small dog toy with me for moments like these where my dog could be silly for a few minutes. It is better to have these “off duty” moments in the privacy of a bedroom. I had a bit of an attitude of “I’ll take what I can get” when it came to providing my dog with exercise in an environment where I was not permitted to exercise myself. Leaving my bathroom door open made the room a bit “larger” to play fetch and utilizing a treat ball/toy for meals gave my dog a little mental and physical workout twice per day. (Utilizing both sides of a suite also makes for a great private “playground”- if your suitemates are agreeable to it!)
Service Dog Gear:
So, I hate to break this to you but, your service dog’s working gear could be a safety hazard and therefore be contraband. One of the ways I cope with necessary contraband items in rehab is with the “diaper bag” method (scroll down for more on that). But, some things, (like a metal mobility harness or a prong collar) could pose an unfortunate conflict of interest for your safety and your wellbeing during treatment. You may need to be prepared to handle your service dog without a harness, or collar, or leash. This might sound unreasonable, but it’s very possible. Especially when some psych wards don’t even permit canes or crutches, causing patients to resort to wheelchair use during their stay.
Is your dog capable of working off leash? Do they obey verbal commands or hand signals well enough to do their job without a head collar or treats or a prong or e-collar? Do you require door tethers in your room/bathroom that might be taken away? These are things to consider before a planned admission with your service dog.
During my first admission I was able to use our door tether, a leash and collar, and all of my training tools without any issues. During my second admission I had my leashes and tethers restricted, for my safety, but was permitted to use a 6 inch traffic loop with a plastic Starmark prong collar (because I seemingly couldn’t harm myself with either). During my third admission, I was only allowed to use our e-collar system and had to turn it in to the nurse’s station at night (they would also kindly charge it for me). During all three admissions, I was permitted to keep our nylon counter-balance (mobility) harness on my dog at all times.
The “Diaper Bag”:
Having a service dog is like having a toddler. And, just like with a toddler, having a service dog typically involves carrying around a bag of supplies just for the dog. This is where I introduce our “Diaper Bag”.
The diaper bag contained everything for my service dog that I would not be allowed to have with me in my bedroom at treatment due to contraband rules or safety restrictions (sharps, ligatures, etc.). But, these are things that I need multiple times on a daily basis for my service dog and cannot be locked up because of this frequency. So, I got myself an actual diaper bag and loaded it up with everything we would need that would be kept at the nurse’s station in a secure location.
Some of the things kept in the diaper bag were:
- poop bags
- eating disorder facilities do not allow patients to have plastic bags or containers
- psychiatric facilities in general could consider plastic bags a safety risk for suicidal patients
- cans of dog food (sharp metal)
- be sure to pack wet food that doesn’t need a can opener
- dog food in general
- unsealed kibble is a hazard because contraband could be hidden in the kibble
- a patient (even the handler) could potentially choose to eat the dog food, thus, a safety hazard
- sometimes dogs need human food and eating disorder patients are not allowed to have access to food that is not on their meal plans
- dog food bowl (container)
- metal grooming supplies (sharp)
- metal tooth combs and brushes, nail clippers, etc.
- I highly recommend bringing some grooming supplies that aren’t contraband to keep on hand in your room for daily touch-ups (Kong Zoom Groom is terrific). It’s just easier sometimes, especially if the mood strikes you in the middle of the night to brush your dog.
- doggy first aid kit
- pretty much everything in a first aid kit will be considered contraband in a psychiatric facility
- we used our first aid kit several times
- I highly recommend having one for your service dog as the facility will not be able to distribute medications or supplies to the dog
- however, the facility did provide hydrogen peroxide for an injury my dog sustained because I needed a lot to clean a wound (they were not obligated to do this in any way and it was merely an inexpensive favor). I was closely supervised during this.
- collars and leashes (ligatures, metal)
- charger for an e-collar (ligatures)
- a favorite dog toy that might be considered contraband (ligatures, stuffed animal)
- some facilities might not permit cloth toys due to sanitization issues
- some toys *could* be used as a weapon
- some toys could be used for self harm in various ways
- stuffed animals can be used for smuggling contraband
If I think of anything else we had kept in the diaper bag, I’ll add it in.
I had no problems at all at Renfrew asking for the items and dog food in our diaper bag. It was usually easy for staff to access and I could ask any clerc, counselor, or nurse to grab something for me. Some things required me waiting for supervision in order to use them. When it came to poop bags, I was usually given two (one as backup) and was expected to return the extra one if I didn’t need to use it. The protocol we set for poop bags was much like the traditional “napkin protocol” used in several eating disorder programs.
My first and second admissions permitted me to keep our e-collar charger in my bedroom. My third admission necessitated that the charger be kept in the nurse’s station, where they would charge it in plain sight so I always knew where it was, but they also let me keep all of the dog kibble in my room that admission. Every place and every admission will be different.
Dog Poop and the “Dookie Bin”:
For lack of a better term, I called the “place where we put the bags of dog poop” our “dookie bin” and the poop bags “dookie bags”. (See my section above, “Diaper Bag”, on how the poop bags were restricted by the facility.) Maybe the name was dumb, but it worked. So, because I was in eating disorder treatment, we were not allowed to have bags or containers in which we could store and hide food or vomit. Also, being in eating disorder treatment, long walks were not an option (including the walk down to the facility’s dumpsters) because those are considered exercise and exercise is verboten.
I didn’t want to have to triple-bag every “deposit” my dog made just to throw it out inside- or even risk making the inside of the facility smell like a farm. So, I brought my own “dookie bin”. This was a small trash can from the dollar store that had holes all over it to prevent it being used for illicit eating disorder activities and therefore not being contraband. This bin was kept in a designated location, as directed by maintenance, and was typically emptied on a nightly basis by maintenance staff.
My second admission to the facility was rather sudden and so I didn’t bring a bin with me. The facility provided a bin in the same location and it was maintained as before. My third admission was to a different facility that happened to already have a pet waste bin and free bags- so I had no issues whatsoever there.
Basically, potty breaks will function different everywhere. My first admission, I could take my dog outside independently during any break period (and then some) but was not allowed to go on “walks” due to exercise restrictions. My second admission, I had to ask before going outside (for my safety) and stay within view of the nurses’ station (the front doors were glass). My third admission, I had to be escorted by staff and one time was not permitted to leave my bedroom (for my safety) so a staff person volunteered to take my dog out for me on-leash. (They were so awesome and my dog got a full walk and was really happy.) For these admissions, my dog typically peed on mulch or grass. At the outpatient facility I went to for IOP and PHP she would pee on ivy in the garden. Some rehab facilities are in places where foliage is very sparse (think: Arizona) and your dog may need to know how to pee on gravel or sand/dirt.
Some facilities may not allow a patient to go outside at all. Hospitals are not required to provide a dog walker. Be prepared to have to possibly pay for a dog walker to come multiple times per day (or friends/family) to potty your dog. Be prepared to advocate for yourself to have a staff person escort you as a reasonable accommodation. Be prepared to ask that smoke breaks be utilized as potty breaks. Be prepared to have to utilize puppy pee-pads, a doggy litter box (indoor potty), or an indoor dog lawn for high levels of psychiatric care that won’t permit you to go outside at all. Be aware that your health insurance might cut your care if they learn that you are being permitted outside, even for your service dog to potty (because, to American insurance companies, this supposedly indicates that you are “healthy enough” to not need to be in the hospital).
If you are planning an admission to an inpatient or detox facility, be prepared to effectively advocate for your service dog’s potty needs. If your facility cannot accommodate outdoor potty breaks, then you need to make sure your dog is capable of utilizing indoor potty methods and you’ll need to advocate for those methods to be accommodated. (Research and ask around about how service dogs “potty” on cruise ships for more ideas on how to manage indoor potty methods.) (I will try to link to something about this in the future, currently the only information I know of exists in closed Facebook groups. Ask around, though. Somebody will know someone who went on a cruise with their dog.) (Here’s an interesting forum related to service dogs on Disney cruises.)
Eating Disorder treatment comes with a host of contraband restrictions that aren’t typical of other psychiatric facilities. This includes the “containers” restriction common at most eating disorder facilities which impedes the ability to use dog bowls or poop bags. I had been in eating disorder treatment twice prior to my first admission with my service dog, so I anticipated this obstacle readily. For the bowl issue, I asked, as a reasonable accommodation, if my dog could have a water bowl set up near the nurse’s station. The request was readily granted and I had a gallon of water, a little mat, and a water bowl set up next to the nurse’s station which we could access at any time and also walked past frequently (my dog would signal that she wanted to stop and take a drink).
During my second admission I got away with just having the bowl in my room. I just didn’t even ask and it didn’t get confiscated during admission or even room searches. During my third admission I was hardly ever in my room because I was under strict supervision from dawn ’til dusk. Luckily, my room was in a highly foot trafficked area for the program (and basically next to the nurse’s station anyway), so I chose to keep the water bowl just inside my bedroom door with the door propped open at all times. This functioned in the same way as the nurse’s station water bowl from my first admission and we had no issues keeping my service dog hydrated throughout the day with this setup. Whenever I was in the med line (usually three times a day or more), my dog’s bowl was right there. Whenever we got escorted for a potty break, we’d pass her bowl on the way and back and it gave us an opportunity to also have a “water break”.
Dog Tags and Microchips:
Get a new dog tag made up with an emergency contact for your service dog’s collar. This number should be someone who is able to be responsible for your service dog, should something happen to your or your dog, while you are in treatment. “Owner is in hospital, ICE call: ###-###-####” works fine to get the message across regarding your dog’s temporary emergency contact. Shit happens. Your service dog could run away somehow and get lost. You could end up in a higher level of care where you’re unable to make decisions for yourself or for your dog. You could end up in the ER. Lots of things could happen.
Update your dog’s microchip registration to include that secondary emergency contact’s information as well as information on where you are being treated (effectively, your “temporary address”). If you’re not sure where your dog’s microchip is registered, you can look up their microchip number via the AAHA Universal Pet Microchip Lookup database. Some companies may charge you a yearly fee to update your dog’s information. You can update your dog’s microchip for free at Found.org and they will allow you to include loads of information on your dog and any special veterinary needs your dog may have. The updated registration will be available on the AAHA database as the most recent entry (you can go back and check this for yourself).
Transitional Living: If you’re going to be living in transitional housing for a period longer than 30 days after inpatient or residential treatment, be sure to talk to the city or county in which you are residing during that time. You may need to register your dog for a dog license in that locale. Many times, you will not need to do this. But, if you’re looking at 6 months to a year of transitional/sober living, then it’s a really good idea to register your dog in case anything happens to them. Check Animal Law to see if the state you’re staying in waives registration fees for service dogs. (You probably do not need to worry about this for inpatient or residential treatment. I have called cities prior to admission and their offices assured me that I don’t need to register my dog because I’m not living in their city and won’t have a real address or bills for utilities in that city. Literally do not fret over these details. It’s much more important that you get admitted as soon as possible. If anything, just keep your dog’s registration up to date in the town you do live in and have family handle renewal for you if you will be gone during a renewal period- such as December through January.) [note to self: create a section on transitional living and DTLA that covers service dog access under the Fair Housing Act and ADA]
I have experienced…
I’ll get back to this topic later. Basically, I brushed the dog, de-shedded the dog, and used wipes on her.
Preventatives and Dog Medications:
For all three admissions, I was able to use a flea collar (we use Seresto) for my service dog. Not all facilities will be able to permit flea collars, however, for safety reasons (ligatures). If you are planning to be in treatment for longer than a month, be prepared to plan for switching up your flea/tick prevention routine for admission. Talk to the director of the ward ahead of your admission to discuss whether a flea collar is permissible or if your dog needs to switch to either a topical or oral preventative during your stay. Ask about how the facility will accommodate you so that you can administer the dose to your dog, since it will be considered a chemical (topical) or medication (oral). This goes for monthly heartworm preventatives as well, which are typically oral. Discuss with your veterinarian which options are available for your dog’s needs. There are several options including an injectable heartworm preventative (which protects your dog for several months) as well as some oral preventatives that protect against both fleas and heartworm.
If the facility you are staying at permits outdoor walks or passes, be sure to consider whether a tick preventative will also be necessary for your dog. Research the prevalence of ticks in that region and ask around online.
I kept a stock of Zyrtec, fish oil, Benadryl, and gas tablets in my dog’s “Diaper Bag” behind the nurse’s counter during my first and second admissions. It wasn’t really tightly controlled and, honestly, I was surprised at this. However, lucky for me, it meant that my dog’s allergies and digestive issues could be addressed without much staff involvement or interference. During my third admission, all “Diaper Bag” type stuff was locked in a contraband closet. Lucky for us, that third admission was across the country and my dog didn’t have many allergy issues there at all. I think that third admission would have handled my dog’s medications in the same way in which they handled our canned dog food: kept in the same bag in the same locked closet (where a nurse or counselor would escort us to grab what we needed).
Boundaries and “Petting” Policies:
Every service dog team is different when it comes to “petting policies”. Some organizations that train service dogs will tell their clients “no petting” is always the rule on-duty. Some organizations and private trainers may also recommend that a service dog not play with or bond with any other persons except for the handler while off-duty. Many organizations don’t have these rules. For the owner trained teams, it is personal choice.
When I was in treatment, I was asked by a therapist that I not allow other patients to pet my dog during groups. I thought this was both fair and a good idea. The facility had a “no distractions” rule during all groups- which meant that fidget toys, knitting, journaling, and crossword puzzles were all banned during group times. I felt that their request fell in line with the general expectations of the facility and was not unfair because I was still allowed to engage with my own service dog however I needed to during group times. Now, I personally enforce a “no petting during groups” rule whenever I’m in treatment. It simply makes sense.
I am generally very lax with boundaries when it comes to my service dog. In general, I tell people simply to ask me before petting or engaging with my service dog. I have a hard-fast rule that when I’m using her mobility harness, that no one is permitted to talk to her or pet her. If I’m just chilling during down-time, I let people fawn over her and I even let my assigned roommate treat her as a pet when we are in our bedroom at night. I usually don’t mind this and feel that it helps me to create social connections with others. However, just because I don’t mind doesn’t mean that you, or another handler/team, won’t mind. Be vocal about your “petting policy” and stick with it. And, sometimes I do mind and will say so if it becomes a problem for me.
During my first admission to treatment, the facility tried to strongarm me into signing a “no petting” contract after I was admitted. I think they were afraid of liability issues with either my service dog becoming injured by another patient or (more likely) that my dog could injure another patient. I was taught early on that it is not legal for an ADA covered entity (such as a rehab) to require documentation for a service dog- this includes contracts. I held my ground and said “If you want to institute a behavior contract regarding interactions with my service dog, then you need to have that contract with the community (of patients)- not with me.” Meaning, if they are so concerned about this, then the hospital itself needs to make the rule “patients are not allowed to pet another patient’s service dog” and have every single patient sign a contract to that extent. Why? Because this puts the responsibility on the hospital and staff to enforce that rule- not me. And, if a patient breaks that rule, it would be that patient who gets reprimanded- not me. As a patient, it is not my responsibility to manage another patient’s behavior.
It is, however, my responsibility to manage my own behavior and uphold my service dog’s behavior to the standards put out by ADA law.
My dog was trained to use a battery operated doorbell as an emergency alarm to alert for help in the event of a fall when I’m bathing/showering. At home, this task is usually performed with a cordless phone. In rehab, I don’t have access to a phone. So, I bought a doorbell. (It’s actually the same doorbell inside of the Pebble Smart system for dogs, without the fancy packaging.) We informed nursing staff of how this system worked and they would keep the battery operated doorbell receiver on their desk. This was helpful, not only for falls, but also for when I was bedridden due to my physical disabilities and refeeding.
We learned the hard way that my wireless system has a limited range. I regret now not buying a more expensive system with further reach. If anything, just make sure you have the nurses test the range while you press the button so that they can leave the receiver in a reasonable spot.
During my third admission, I brought the doorbell with me but didn’t ever need it. Not only was I never in my room (because of day room supervision), I also was eventually put on supervised showers- so I had staff right there for me anyway. Even if I wasn’t under such strict supervision, my suitemates (roommates) were so awesome that it wouldn’t have been a problem either way.
A note on airline rules and documentation: Please review the new airline rules set by Delta and some other airlines as of March 2018. They require more documentation for travelling service animals, which will complicate things for persons seeking medical and mental health treatment from afar. Also research the Air Carrier Access Act for information on access for service dogs, psychiatric service dogs, and emotional support animals. [note to self: include updated information on documentation requirements and how this affects persons travelling long distance for treatment with their service dog, link to a blog post on training a service dog for air travel including TSA pat down and tucking under seats]
Renfrew, when I went, didn’t seem to be very experienced with ADA law and it took a lot of self advocating to clarify that they could not legally ask me for documentation/papers/etc on my dog. I’m a little overwhelmed right now with the details and will come back at a later date to discuss such. In the end, they were super accommodating of my service dog and I really didn’t have any issues meeting her needs while I was there. (Note to self: include info on the “diaper bag”, “dookie bin”, scissors, tuna/bananas, poop bag protocol, and dog crate)
Label your stuff. Address labels for letters work. Print a sheet of labels off with some Avery label paper. Hell, just write on the labels yourself- no computer needed. Use duct tape, if you need to. Just rip off small pieces of duct tape and use a permanent marker to write your name and stick those home-made labels on everything important that you own (note: in rehab you will not be allowed Sharpies or rolls of duct tape- those are definitely contraband!). Basically, rehab is like summer camp from hell. Label everything if you want it back when you leave.