As COVID cases decline, many Arizonans are headed back into the office for the first time in more than a year, which can cause serious anxiety.

Therapists teach mindfulness techniques to help people recognize their stressors and deal with them.

Dr. Nika Gueci, executive director of the Center for Mindfulness, Compassion and Resilience at Arizona State University in Phoenix, offered suggestions to cope with anxiety.

"So give yourself permission to feel what you're feeling without judging," Gueci advised. "And then figure out steps that you can take; your own personal tool kit to how you can fill yourself back up whenever you're depleted."

If you're feeling anxious, Gueci recommended taking three deep breaths, unclench your jaw, and drop your shoulders. Long term, you can work on eating better, exercising and getting enough sleep. And she pointed out blaming yourself for feeling uneasy only compounds the suffering.

Dr. Nicole Brady, chief medical officer for United HealthCare employer and individual for Wisconsin and Michigan, said the disruption of our routines is the biggest stress trigger when returning to the office.

"Packing a lunch ahead of time, knowing how we're going to get kids to and from activities," Brady emphasized. "But stepping back and doing some advance planning can really alleviate some of that return-to-the-office stress."

She added mindfulness and relaxation apps can be very helpful in reducing anxiety.

Advocates said the kids aren't all right and want to tackle the youth mental health crisis head on in schools.

A study of Maryland's youth mental health care found 67,000 children in the state suffered from major depression and nearly half did not receive treatment.

In Maryland schools, the ratio of psychologists to students is nearly five times the recommended ratio. Even worse, the ratio of social workers to students is nearly 10 times the recommended ratio.

Angela Kimball, chief advocacy officer for the mental health advocacy organization Inseparable, said increasing school-based mental health services would overcome barriers some students face when trying to access care.

"They're less stigmatizing," Kimball pointed out. "They normalize mental health care. They're available without cost. They don't require transportation or parents taking time off work. School mental-health services offer this opportunity to reduce barriers and get kids the support they need."

Youths who receive school-based mental-health services are six times more likely to complete a full round of treatment, according to a U.S. Department of Education report.

Other studies have shown teaching students mental health literacy and life skills decreases symptoms of depression and anxiety. Kimball emphasized other states are expanding the ranks of their mental health services and including other students to help their peers.

"That means not just school mental health professionals but also expanding that workforce to take advantage of other caring adults and youths and young adults, who can actually provide support to their peers," Kimball explained.

Kimball argued Maryland should expand its school Medicaid program, which allows more money to flow into schools to better fund mental health services.

While New Jersey has made gains in K-through-12 mental health support, advocates said the state needs to do more.

In recent years New Jersey has passed legislation and seen a mix of state and federal grants awarded to help expand access to school based mental health services. In December, Montclair State University was awarded a federal grant to recruit and train school psychologists. Last fall, Rutgers University announced a similar grant aimed at increasing the number of highly trained school counselors.

Angela Kimball, chief advocacy officer for the mental health advocacy organization Inseparable, said for many people accessing mental health services can seem intimidating.

"When we offer mental health services in schools, it serves to actually normalize the idea of getting support for your mental health," Kimball explained. "That really reduces stigma, and it reduces other barriers to people getting the kind of support they need to thrive. "

The American School Counselor Association recommends a ratio of 250 counselors per student. New Jersey has improved its ratio from 2019 when it was near 350 counselors per student. In 2024, the number was just under 300 to one.

The state is currently in the second year of the New Jersey Statewide Student Support Services network, which offers support to all students in the state through 15 regional hubs. The hubs are staffed by prevention specialists and licensed clinicians, and can deliver services in schools, other community settings and virtually.

The hubs offer three tiers of services ranging from workshops in tier one, to prevention services in tier two for groups of at-risk students and individualized intervention services in tier three. The program was intended to replace existing school-based services in place since the 1980s at 90 schools throughout the state. The school-based programs were preserved after some pushback and Kimball noted research points to benefits for keeping services in schools.

"Research is showing that youth who get school-based services are six times more likely to complete a full course of treatment than with community-based treatment," Kimball reported.

Last year, the New Jersey Department of Education found 13% of 12-17-year-olds in the state reported at least one major depressive episode in the past year, with 8% reporting a severe episode.

More than 1 million Coloradans are living with a diagnosed mental health condition but insurance companies are denying coverage for care their policies promise to pay for.

Jake Williams, CEO of the advocacy group Healthier Colorado, said insurers reject many claims as not medically necessary, even when a doctor has prescribed the treatment.

"Seventy-five percent of Coloradans with commercial insurance, who have a diagnosed mental health condition, have not received the care that they need over this past year," Williams reported. "There are real consequences to this."

In 2008, Congress passed a law requiring insurers to offer the same access to mental health care as to physical care. But a loophole in the law allows insurers to determine what care is "necessary or appropriate."

An investigation by ProPublica found UnitedHealth Group was using algorithms to deny claims, a practice later deemed illegal in three states. United defended its claims program, arguing it ensures patients get safe, effective and affordable treatment.

David Lloyd, chief policy officer for the mental health advocacy organization Inseparable, said insurance companies should not be denying care using standards inconsistent with accepted clinical standards. He believes there are roles for both state and federal lawmakers to address the problem.

"We're encouraging policymakers across the board to take some common sense steps to ensure that health plans are ultimately covering the services that they promised to cover when you have health insurance," Lloyd emphasized.

Williams pointed to a bill recently introduced in the Colorado General Assembly as one path forward. The measure would require insurers to cover treatment using criteria developed by the American Academy of Child and Adolescent Psychiatry, or the American Association for Community Psychiatry.

"What we'd like to do is make it uniform," Williams stressed. "So that just like physical health there's a standard definition of medical necessity, so insurers and patients and doctors are all on the same page, and patients are more likely to get these critical services covered."