There are dog/wolf visuals in Dolly's route, but these are mostly for cynophobia imagery if anything due to Dolly's trauma and the presence of her wolf alter. No dogs die, and the wolf alter turns out to be friendly-if-misguided.
Not in the traditional sense. The plush toys resemble various animals and the game explores a lot of their trauma, which are mostly things that sentient toys would go through rather than things that would happen to actual animals. Still, the fact that they resemble animals may add an extra distressing layer.
Kind of. Each toy has some kind of deep-seated trauma that could be analogous to child abuse. Dolly was used as a literal chew toy for her owner's dog, Lilo had test answers ripped from the mouth in public, Kroko was used to mop floors, Sly's owners used him to smuggle drugs, Dub has abandonment issues from his owner accidentally leaving him behind, and Dr. Wood spent time in a display case away from anyone. The game is about helping them overcome their trauma.
The plush toys resemble animals, and each has trauma resulting from the way they have been treated by humans. Dub explicitly has trauma from being abandoned, while Sly was at one point tossed onto the road by his drug-using owners.
Dolly and Lilo both self-harm in their routes. Dolly has a phase where she lashes out at herself, where she rams her head into various objects, and tries to stab around the chest area with a knitting needle. The solution to this give her a therapeutic interview, and then give her occupational therapy in the form of knitting. Lilo has trauma involving his mouth, and can also hit himself. One phase has him put a safety pin through his lips, and later self-induce vomiting (which the game describes as bulimia).
All of the patients have trauma, which you need to treat. Dolly, Kroko, and Dr. Wood all have trauma-based disorders (DID, phobias, and NPD, respectively).
Dr. Wood gaslights everyone in his route. If you read the 'professional help' tips, they are presented in a way that implies he forged them as they're way too glowing in their descriptions of him. The route then has him essentially start a cult in the asylum, as he manipulates the patients and staff into giving up their belongings in exchange for talismans. This is resolved by the end.
The game actually treats the subject of mental health tactfully, and the goal is to help the patients recover. However, Dr. Wood's route has him essentially start a cult in the clinic, clearly exploiting the patients to stroke his own ego. This is resolved by the end.
Towards the end of Lilo's route, he vomits up various personal objects from his owner, which the tips describe as an act of bulimia. It's established that he has trauma around his mouth and things inside him.
Potentially? Lilo's arc has him reuniting with his owner, who used him as a way to hide test answers which led to a guilt complex when the teacher found out. At the end of Sly's route we hear the same music that plays in his flashback, possibly implying that his drug-using owners responsible for his overdose came to pick him up.
One of the patients, Lilo, explicitly has autism. It's eventually revealed that he has trauma from his owner using him to smuggle test answers, which resulted in the teacher ripping open his mouth and taking the contents out in front of everyone. He found it anxiety-inducing to the point of developing bulimia, and harbors guilt over the incident. It is possible to use wrong treatments to worsen his mental health, though the game punishes you for it.
Dolly has problems with anger and anxiety, which is ultimately revealed to be the result of DID symptoms. She engages in acts of self-harm throughout her route, and it's described that she came to the clinic because she was acting aggressively in the daycare she was in. Her arc is about her coming to understand the trauma and her wolf alter, which came from her previously being used as a dog's literal chew toy.
A few of the toys have body issues. Dolly is distressed by images of herself due to dissociation, Sly has a complex around his tail due to it being crushed and unable to rattle, Lilo has trauma surrounding his mouth which leads to self-harm and bulimia, and Dub is a compulsive exerciser who falls into a depression when he realizes just how out-of-shape he is.
'Drug administration' is a treatment method in the game. When you click this option, you see a hand inject the patient, which is followed by a hallucination sequence. This is mostly in a treatment context. The reveal of Sly the Snake's route is that he was used to smuggle drugs, which were accidentally crushed when he was tossed onto the road and run over. His symptoms are the result of an overdose from this incident, which you then treat through surgery at the end of his route.
Dr. Wood starts out as one of your colleagues, but as the game progresses he basically starts a cult in the clinic due to his own personal issues (NPD). It's eventually revealed that he has a history of neglect due to being kept in a display case in a doctor's office, away from any love or affection but still admired from afar. The ending of his route has him introduced to a child who roughly plays with him, which helps give him the healthy kind of love that he always wanted.
The entire game takes place in a psychiatric clinic, where you play as a doctor treating various plush toys. For the most part, the game treats the patients with compassion, with instances of medical abuse only happening if the player picks wrong options (which the game punishes you for). Medical abuse only becomes a mainline event during Dr. Wood's arc, which initially has him as a colleague instead of a patient. However, his own mental health problems get the better of him, and he starts trying to recruit the patients and staff into his cult. The issue is resolved at the end of the route, and he is implied not to work at the hospital anymore (though he has made a recovery!).
One of Kroko's issues is that he has aquaphobia, and water is a recurring visual motif in his routes. It's eventually revealed that his trauma comes from his owner soaking him in water and using him to mop the school floors.
One game mechanic is that you can give the patient electroshock therapy. Typically, this would be used to treat patients who are in such a deep state of depression after choosing the wrong options too many times. While you could exploit it, the game punishes you by resetting the patient back to the first stage, plus it is possible to accidentally kill a patient using it. So you don't need to use it unless absolutely necessary. The only time you need to use it outside of player error is Dub's route.
While Dolly the Sheep is initially presented to you as a case of anxiety and anger issues, it's revealed that she has DID, represented by her being a flip-toy. However, she's actually a tactful representation of the illness. Her trauma comes from her being given to a dog, which gave her a wolf alter in the present. The game shows her being triggered several times. While the game initially leads to to believe that the wolf alter is evil and dangerous, a chunk of Dolly's arc is helping her come to understand the alter and the trauma that caused it. This is a surprisingly nuanced and accurate portrayal of the disorder, as it presents the wolf as less 'evil' and more reactive, as well as makes it clear that it's the result of trauma. There are some potential gribbles, mainly her only having one alter (people with DID often have more), but these are more for the sake of the format and storytelling.
Sly is a plush snake with psychosis (eventually revealed to be drug-related). He is never framed in a particularly scary light, and the game is about helping him and the other patients.
The game has several unreality segments that most often occur when you administer dreams or use dream therapy, which depicts the patients' hallucinations and dreams from their perspective. The heaviest of these sequences are in Dr. Wood's route, which has several surreal hallucination sequences even outside of these contexts.
One necessary part of treating Dolly is allowing her to make a knit stocking which she uses to cover her mouth. The end of her route has the wolf alter using the stocking on a dog's muzzle during trigger desensitization, which represents Dolly's recovery from her trauma. Lilo has a zipper on his mouth which remains closed for the majority of his route. The zipper is a metaphor for both being nonverbal and trauma involving the mouth.
The game takes place in a psychiatric clinic, and you are there to treat patients who are various plush toys. The game generally treats mental health tactfully, but it may be a trigger for people in recovery. DID, NPD, autism, depression, psychosis, eating disorders, compulsive exercise, and phobias are represented.
There is a treatment method, 'drug administration', which has the player inject the patient, which then plays a hallucination sequence. The reveal of Sly's route is that he was used to smuggle pills (implied to be ecstasy) by his owners, which led to him being tossed onto the road and crushed. His symptoms are the result of a drug overdose you need to treat.
Kroko is a plush crocodile with paranoid psychosis and aquaphobia. He is never framed in a particularly scary light, and the game is about helping him and the other patients.