Pets as therapy, companions, joy-bringers, motivators, exercisers, soothers….

Introduction

We can’t stress enough what a disproportionate impact it makes to patients to have contact with animals, including providing great opportunities for activity and conversation with their (human) visitors. For patients’ separated from their pets while in hospital, it’s really important that the animals are recognised as being essential in their caring circles and as much contact as possible is enabled whether on or off the ward, including through escorted and s17 leave. Of course, in the old days animals were very much a part of life in the asylums, from cats as pets to livestock on hospital farms. Being with animals is one of the best, and simplest ways of improving hospital experience for patients, staff and visitors, and lots of wards are finding creative ways around the obstacles. Although on acute wards the reality is that staff need to take on the extra work involved in caring for an animal, on longer-term wards the responsibility is shared with patients and this is seen as a valuable element in patients’ recovery and rehabilitation.

The most popular arrangements are staff bringing in their dogs for the day and linking up with the local Pets as Therapy group so that a volunteer and trained pet (usually a dog) visit regularly.  Some wards have imaginatively got round the problem experienced by most wards of being on a waiting list for a PAT visitor for months or longer, by staff registering their own dogs with Pets as Therapy and bringing them in on that basis. A recent research study looked at the effects of Pets As Therapy visits on the mood state of people in nursing homes and attending day care centres. Results showed that even brief Pets As Therapy visits significantly improved mood state regardless of whether participants were in nursing homes or attending day care centres. There are a zillion (well, lots anyway) of research studies and books providing compelling evidence and moving examples of the disproportionate benefits that hospital patients experience from being with animals.

Our top ten pet points are:

1. Pets are definitely allowed onto wards! The Care Quality Commission and the Department of Health have confirmed this, with the simple and important requirement that this fits in with Trust policy and with patients’ needs and care plans.
2. The evidence base for the therapeutic benefits of contact with animals is huge and compelling.
3. There are several excellent Trust policies on animals, listed in the resources section below eg N E Lincs Policy for Pets on Inpatient Mental Health Suites
4. The State Hospital in Scotland, a high secure unit, is blessed with a Pet Therapy Centre. Brilliantly they’ve produced a beautiful, inspiring and practical guide to the therapeutic use of pets in mental health hospitals – Animals as Therapy in Mental Health.
5. Contact with animals can be on the ward (with resident or visiting pets), off the ward but within the hospital (usually with animals in the garden or a mini-farm) or off site (eg patients helping out at local rescue centres or farms.)
6. Pets can be as low-key and low-cost as a goldfish, or a major feature of ward life with a cat or dog.  Small furry things (hamsters, guinea pigs) are a great compromise and patients, staff and visitors get much pleasure from caring for and playing with them.
7. There are practical ways round the fact that some patients definitely won’t want contact with animals because of allergies, phobias, religious beliefs and other factors. The important thing is to plan for this – eg by having a pet shared between several wards so that if one ward can’t house the pet for a period, another one can.
8. Although actual, real-life furry/finny/funny pets are the best, if that isn’t possible then there are all sorts of imaginative ways of including animals in ward life, from photos to soft toys.
9. Conversely, animals can be used as a structured part of therapy, through Animal Assisted Therapy.
10. For many of us, our pets are an integral part of our family so it really helps when this is recognised in care plans, home leave, visits and everyday conversation.

Ward examples

 Patient’s own pets

•  All patients are asked about their pets and the pet’s welfare on admission.
• Families can bring pets to the unit to visit.
• Family and carers are encouraged to bring pet into hospital grounds so that patient can still have contact with them.
• Visitors are encouraged to bring pets to the hospital, an example being that some relatives bring their pet dogs when they visit their relative.

Pets on ward

• Many wards have Pets as Therapy dogs visiting.
• Cats and guinea pigs currently top the list of wards’ own pets, with fish (unsurprisingly) the most common pet for patients to have with them.
• Fish in a sealed aquarium unit which staff will oversee.
• Garden designed to attract wild life – birds, bees, butterflies and the odd squirrel!
• Chickens are starting to be seen amidst the parsnips and petunias on hospital allotments.
• The Head of Therapies brings in her dog who the patients take for walks and practice training techniques.  There is a hamster which plays an important role in enabling patients to regain their equilibrium. The patients have also started having horse riding lessons which has been very popular and a great mood lifter.
• A member of staff guide dog ‘’Tom’’ is a regular visitor to the ward.
• [Welcoming pets on wards is] not before time and would have a huge impact on our service users., we have our own, search/sniffer dog and she visits wards and service users when she’s not working also and has been used very successfully to help a gentleman who was extremely unwell mentally to go to the local hospital as he wouldn’t leave the PICU before and he travelled with the dog and she visited him in the general Hospital also!! We had tried everything to try and persuade him to go to hospital before that and she had the magic touch so to speak, I’m a huge fan of pets on wards.
• There’s a kennel in the ward garden, with a plaque for George Junior above the door. The eponymous part-time resident is a whopping Great Dane, ‘Pets as Therapy’ registered dog. His human is an OT and George Junior enjoys taking patients for runs around the garden and nearby.
• The hospital’s Pets Corner has three guinea pigs.
• Have a physio Assistant who brings her dog into the unit one day a week (it even has its own I.D. name badge on its collar), and she runs a long-established ‘dog walking’ group.
• Having a pre-training Guide Dog puppy. Great idea!
• One hospital is blessed with beautiful, extensive, wrap-around grounds, including steep banks which are difficult to mow, so they’re considering getting sheep!
• A hugely popular animals’ day was held, with visitors ranging from reptiles to rodents. Patients bravely and enjoyably cuddled even the slithery snake.
• We invited a falconer to the ward. He brought 5 birds with him. The patients were able to interact with the birds at close range, and were allowed to feed them and fly them from perches on their wrists. The photographs taken that day are prominently displayed on the ward. The patients were so delighted by this close encounter that the falconer has been invited to make a return visit in May.
• Visiting birds of prey – very popular.

Contact with animals off the ward

• Patients access the local dogs home for volunteer work and also to pet the animals.
• Supported visits to pets are arranged where possible.
• Patients visit the local city farm to help with animal care
• Horse-riding. This happens quite often in private sector hospitals but it’s worth checking if you have a local Riding for the Disabled group which could provide rides or other contact for some patients. Equine Assisted Therapy for people with mental illness is becoming increasingly well-established: A relationship developed with a horse can offer challenges to help overcome fears, build up trust, respect, compassion, develop communication skills, problem solving & coping techniques, self confidence and self esteem. These skills are transferrable to many other areas of ordinary day to day life.
• Falconry training takes place in grounds
• Patients have access to Local RSPCA dog-walking scheme.
• Occasional visits from keepers of reptiles/unusual pets

Animal related ideas

•  A pets wall within the ward for staff or service users to put up pictures of their pets to create a discussion point and brighten up the ward!!
• A ‘virtual pets corner ‘ i.e. developing a pet photo display of patients’ and staffs’ pets and wards sponsoring an animal e.g. a retired donkey or a guide dog
• Occupational Therapy encourage the use of pet photographs, and encourage the sharing of pet stories and pictures within the recovery sessions.  Photographs can be enlarged and placed on display boards, or placed within an individual’s Wellness Recovery Action plan ‘Box of Delights’.

The word from the ward

• “One of our porters brings her dogs to work. She leaves them in the car with the boot open and a safety mesh on and we get a group of patients and take the dogs for a walk around the grounds. It is good exercise for the patients and the dogs and it also helps bring the patients together. It’s also a good bonding session. It helps builds their confidence as we often notice that the quiet and slightly withdrawn patients will take charge of the dogs leads and this helps bring them out of themselves a bit. We also have a good chat and a laugh over who is going to be in charge of the poop scoop!”

More great ideas

The dog prescription

The Dog Prescription is a 10 point prescription style document based on extensive Dogs Trust research which outlines the ways in which dogs are good for humans.

View it here

Sherwood House’s Tilly

Tilly the red-tailed kite is famous throughout Cambian Group hospitals. In her specially- constructed aviary she has been a part of life at Sherwood House for five years, since a patient with a love of birds brought her in from the community. Tilly has now been joined by two ducks and four chickens. The ducks were recently hatched from eggs incubated in hospital manager Nita Roper’s office and caused quite a stir among staff and patients.“Lots of patients were really interested in the eggs and everyone wanted to have a look at the newborns,” said therapy coordinator Laura Atherton. “Now they are in their pen outside and a lot of patients want to help feed and clean them.”

Peacocks and colleagues

We have for the past few years now we’ve had rabbits, guinea pigs, finches, cockatiels and peacocks and we have currently 4 rabbits and 8 guinea pigs. Patients take turns to clean out and feed etc.. We did consider having sugar gliders.. but I had to say no to any animals being housed inside the building  due to concerns for allergy amongst the patient group, attracting mice etc if not cared for correctly. We did at one point have ferrets  but they were not so friendly.. so I would not recommend them unless they are used to be being handled. Rabbits have been taken to other wards for holds and fuss etc,  but again  some patients can be sensitive to the fur.. so any engagement with the animals or birds, follows risk assessment and physical screen by the ward doctor.

– Branwen Ward – Ty Llywelyn, North Wales NHS Trust

From Star Wards’ newsletter #49.5:

The day room was light and airy; the big sliding doors were opened onto the garden and an enormous lawned area. One of the patients appeared carrying two oversized babies’ bottles filled with warm milk. I was invited to follow round to the other part of the garden where the ward’s two lambs, Alice and Bruce, were about to be bottle fed. I didn’t need to be told what effect taking care of these animals was having; I could see for myself the care and affection being lavished on them by the patients. I was given the chance to bottle feed one of the lambs myself so was able to experience that indeed pets as therapy really works – it was a really fantastic experience, that had me smiling and laughing as the lamb tugged eagerly on the bottle, not stopping to draw breath until it was completely empty.

One patient in particular has benefited greatly from taking care of the lambs while others had made the ‘hutch’ (not sure what you call an impressive wooden, straw lined ‘house’) for the lambs to sleep in. This was made in the unit’s workshop where patients can get hands on experience with many wood work projects. For those of you worried about what usually happens to Welsh lamb and what effect this might have– no need to worry, Bethan lives on a farm and is taking the lambs to live with her when they mature to full grown and next year the ward will become foster parents to another pair of orphans to hand rear.

A little note from Marion Janner (founder of Star Wards)

Biscuit

Unfortunately there are loads of genuine, bureaucratic and plain stupid complications about getting pets onto wards. An astonishingly good substitute is the interactive toy dog from Furreal, Biscuit which Derbyshire are piloting on a ward for elderly patients.

I was astonished that stroking and cuddling Biscuit is such a similar experience to messing around with Buddy. He’s ridiculously lifelike, not just size-wise but by responding to voice commands, and spontaneously doing irresistible things like wagging his tail, putting his head to one side (more Princess Di than Buddy), whimpering (more Buddy than Di) and panting (we’ll leave it there.) Playing with Biscuit triggers ‘emotional memories’: warm feelings are evoked from our experiences and memories of being with other dogs. Become a Biscuit pioneer! Make your patients, visitors and colleagues very happy with a social and recreational purchase whose benefits are second only to the invaluable Wii. John Lewis are selling Biscuit for £75 which is a real bargain and something that League of Friends may be happy to pay for. (But! Biscuit takes 6 huge, D batteries, so rechargeable batteries and chargers are pretty essential.)

Our youtube channel has a video of my older foster son Eddie playing with Biscuit. http://bit.ly/wardskelly. Buddy also makes a guest star appearance.

Burghölzli’s therapeutic ward dogs

The Swiss Hospital Burghölzli became legendary as the place where the influential psycholiogist Eugen Bleuler coined the term ‘schizophrenia’ in 1908. (Extraordinarily, these symptoms were previously known as dementia praecox, from the Latin meaning prematurely out of one’s mind.) But we’re excited about this hospital because, fabulously, each ward has a specially trained therapeutic dog. This challenge the craziness that inflicts on mental health inpatient care, health and safety standards appropriate for post-operative wards. If the land that produces the world’s most glorious chocolates are happy about dogs on wards….

Benefits of animal assisted interventions

There are numerous benefits to incorporating pets into human therapeutic work and other interventions such as activity-assisted activities. These benefits can extend to the clients/service users, the person or volunteer who is the animal handler, the therapist and also to the animal.
Benefits to the client may include:

• Physical – eg an occupational therapist might include a dog in the treatment plan to work towards increasing a patient’s fine motor skills.  One exercise might be bending down, holding a brush and brushing the dog’s coat. The dog helps to increase the patient’s enjoyment and thereby also increases motivation and effort in reaching treatment goals
• Psychological – animals can be included in mental health treatment plans to increase self-esteem and self-confidence; help with loss and grief and assist with the development of empathy. AAI can also enhance mood in stressful settings, eg one study reported that pet therapy significantly enhanced the mood of children in a paediatric hospital
• Social – animals can act as a social lubricant and help clients adjust to a new setting or unexpected change in circumstances by facilitating conversations and laughter.

Animals in residence
At Sherwood House, they like to do things differently. “We thought about getting a budgie,’ said Ricky Holland, the hospital manager, “but one of our clients is interested in birds of prey so we ended up with a red-tailed buzzard instead!” She’s called Tilly. Looking after her has been a project for helping to construct an aviary, consulting the RSPB and receiving
advice from a local bird expert. Tilly has given some of the clients a focus, a reason to leap out of bed in the mornings, and a topic of conversation.

Storthfield has gone for something a little easier to catch – Flash the red-footed tortoise! She is at her happiest wandering around the conservatory, occasionally handled by clients. A quiet reptile who is not demanding, all she requires is a daily feeding regime and a regular cleaning schedule which benefits her and provides responsibility for clients.

In the US, ‘Animal-Assisted Therapy’ is held in high regard. A year-long study in a forensic psychiatric hospital showed a 50% reduction in medication, and lower levels of violence for the AAT group compared with the group who had none. A ward with pets had no incidents of serious self-harm; a similar ward with no pets had eight.

Visiting animals
Once a month, the patients at St. Augustine’s have a chance to spend some time with Stella the labrador, from ‘Pets as Therapy,’ who is blessed with a wonderful calming disposition. Staff-nurse Alison made the arrangements. “It’s very soothing to spend time with a dog as placid as Stella and the reaction has been very positive. Patients who are very withdrawn seem to open up when she’s around.”

Visits from Stella allow the patients to build a trusting relationship with a creature who gives unconditional love and affection. Her presence improves interaction between patients too, giving them something in common to discuss.

At Storthfield, Katie, a sheltie who belongs to Monika Payne, Head of Nursing Care, visits the unit regularly to allow the patients to pet and walk her. She’s a gentle dog and wanders around the unit with a supervisor. The clients enjoy her company and spend time talking to her, grooming and
feeding her.

The American Psychiatric Association reports that Animal- Assisted Therapy was associated with reduced state anxiety levels for hospitalized patients with a variety of psychiatric diagnoses.

Animals in the community
Dog-walking is an activity enjoyed by many Cambian clients. From Sherwood, a group go to the Jerry Green Dog Rescue Centre in the neighbouring village of Blidworth. Kelly Brandon, Therapy Co-Ordinator, tells us: “The patients have a dog each that they walk around the field. We have seen improvements in them since they have been interacting with the dogs. In some it has helped their interpersonal skills, morale and motivation. It’s also a little light exercise for some of our less active patients.

Some of the men take treats for the dogs and tins of food, as the kennels relies on donations. Some now have plans to adopt their own rescue dogs when they return to the community, when most would have opted for a new puppy. Some of the men also enjoyed a visit to Twycross Zoo.

Dog walking is good for your health!

It raises the heartbeat from around 80 beats per minute to 140. A raised heartbeat means more blood and oxygen is being delivered to the heart muscle helping to maintain a healthy heart and lungs.

Patients from Aspen House and Lodge have just started horse riding at the Northern Racing College. There are both indoor and outdoor facilities, so whatever the weather, patients can enjoy the activity and exercise.

A group of about five patients go there on a regular basis. There have been significant benefits observed for two patients in particular, who usually find it difficult to participate in group activities.

Adele, who has never ridden before said, “It’s really nice to have the interaction with the horses, they are so gentle. It was my first time, but they didn’t push me, I’m trying trotting next week!”

Denise thinks “It’s a good scheme and good for motivation. The horses like me and I warm to them. I think the indoor facilities are great, I love grooming the horses.”

Horse riding has many therapeutic benefits:

• Reach therapeutic goals: improve muscle tone and posture, develop fine and gross motor movement
• Combat social isolation: build relationships, enjoy events and competition, develop self-confidence
• Develop life skills: improve communication, take responsibility, be a team player
• Experience the outdoors: ride in the countryside, access rural Britain
• Connect with animals: bringing positivity and optimism, adding a new element to life

We could all put our names to a statement from the Pet Health Council: “It will come as no surprise to animal lovers that research shows that pets are good for our health. Contact with animals can bring real physiological and psychological benefits.”

Resources and references

There are lots and lots of compelling, endearing, inspiring stories and evidence about the therapeutic benefits of contact with animals. If you’ve only got time to look at one thing, we’d strongly recommend this amazing resource from the State Hospital in Scotland – a high secure unit with a superb animal therapy programme.

Inspiring examples

Animals as Therapy in Mental Health – essential and very enjoyable reading

How dogs help people with a range of mental illnesses

 Pet farm at old people’s home

Can pigs and goats help people with dementia?

 Eden Alternative and animals as caregivers

Lovely news article about Pets as Therapy dogs being introduced to hospitals across North Wales

Let pets visit hospital patients, NHS told

Information about using pets and animals in therapy with psychiatric patients is available on the Web at www.petsandpeople.org.

Evidence base

Don’t take our word for it. Well, please do and here’s a fraction of the reasons why.

Some Patients Petting Their Way To Improved Mental Health

The Effects of Animal-Assisted Therapy on Anxiety Ratings of Hospitalized Psychiatric Patients. Sandra B. Barker, Ph.D.; Kathryn S. Dawson, Ph.D. Psychiatric Services (1998)

Pets in hospitals

Behaving like animals (Transcript of Radio 4 programme)

Organisations

Pets As Therapy – greatly appreciated provider of dogs and their human volunteers.

Society for Companion Animals Studies – an education charity working to support and promote the health and social benefits of interactions between people and companion animals.

Policies

State Hospital Scotland

N E Lincs Policy for Pets on Inpatient Mental Health Suites

Camden & Islington’s dogs’ policy

Videos

The Pawsitive Pals Pet Therapy Program at San Diego Hospice and The Institute for Palliative Medicine features certified dogs of all shapes, sizes, and breeds who show how they reduce loneliness, depression, stress, and isolation while promoting relaxation and improved morale.

Science behind Animal Assisted Therapy

Heart-melting video of Waggy Tails Club

Video of astonishingly realistic, interactive toy dog. Buddy makes a guest star appearance.

Buddy (Marion’s support dog)

The Buddy effect

Called to heal