Barriers and Facilitators to Psychiatric Service Dog Handler Training Among Veterans with PTSD: A National Qualitative Study

Abstract

Background: Psychiatric service dogs provide task-based support that helps veterans with posttraumatic stress disorder (PTSD) manage symptoms and improve daily functioning. As a complementary human–animal bond intervention, psychiatric service dog training has received increasing attention. However, veterans frequently experience disparities in access to and experiences with service dog handler training. Objectives: This study aimed to identify barriers and facilitators influencing psychiatric service dog handler training among veterans with PTSD to inform improvements in training practices, program access, and mental health support for veteran–service dog teams. Methods: Guided by Donabedian’s structure, process, and outcome framework, this qualitative study analyzed perspectives from 42 veterans and 10 organizational leaders across nine psychiatric service dog training organizations. We conducted one-on-one, semi-structured interviews and analyzed them using thematic analysis to identify barriers and facilitators influencing handler training. Results: Thematic analysis identified four primary barriers to psychiatric service dog handler training: limited access, emotional and behavioral challenges, communication difficulties, and health care system obstacles. Four facilitators were also identified: supportive training staff, veteran peer support, post-graduation services, and family inclusion. These barriers limited veterans’ engagement in training, whereas participants described the facilitators as promoting resilience, strengthening handler–dog partnerships, and sustaining engagement over time. Conclusions: This study provides insight into veterans’ experiences navigating psychiatric service dog handler training and highlights the need to address structural barriers, strengthen emotional and social supports, and improve organizational practices. By identifying key facilitators, including training staff, peer support, post-graduation services, and family inclusion, the findings inform evidence-based improvements to service dog programs and support their role in veterans’ mental health care.