“He's opening everybody's heart up”: Co-creating pet therapy activities with inpatients at a large urban mental health and addictions hospital

Animal-Assisted Activities (AAA) is now ubiquitous in many health care settings around the world. There is growing evidence about AAA's benefits but there is no literature about the inclusion of patients, the end-user, in the design and improvement of these programs. The aim of this study was to co-create AAA activities with inpatients to make their hospital experience in the psychiatric milieu more humanizing. Informed by the principles of Participatory Action Research, we conducted seven focus group discussions with 38 participants in seven different inpatient units at a large urban mental health and additions hospital. In these discussions we asked participants what made pet therapy meaningful for them, the activities they enjoyed, what kind of activities they would like to see more of, and if they had experienced any barriers to their participation in this voluntary, recreational program. Our results show that AAA has four entangled elements: the bidirectional relationship between participant and therapy dog; the capacity of therapy dogs to generate social interactions, a tension between structured and unstructured activities with animals; and therapy dogs as a vector for a deeper relationship with nature. Intentional patient-derived changes to AAA programs would amplify their impact for inpatients in psychiatric care. Providing both human (e.g., clinical support) and non-human (e.g., dog treats) would support patients in their desire to develop deeper relationships with their animal companions. Further, while most research to date emphasizes the therapeutic benefits of AAA, our results demonstrate that animal-led activities that result in positive social interactions with others (including non-human animals) were the most meaningful to participants. • Pet therapy catalyzed positive social interactions and facilitated meaningful reconnections with the natural world. • Participants valued the transformation from patient (as care- recipient ) into care- giver. • Participants felt the program re-humanized their experience of hospitalization. • Overcrowding, poor signage and worry about the dog's wellbeing undermined the program. • Short one-on-one opportunities to bond with the animal were highly sought after.