Mental Health and Substance Abuse Social Work in California

Written by Kim Borwick

showing support in group session

“The patient is whole: mental health, social health — all those affect each other.”

Director of patient and social support services for LA County Department of Health Services, Charmaine Dorsey emphasizes the role of the social worker in mental health and substance abuse treatment as a way to bolster individual and community health by addressing the interconnected psychosocial factors that influence California’s health care system and its communities at large.

LA County’s integration initiative, which provides social care resources through primary care clinics, was dubbed “behavioral health integration” at its inception, but now — in addition to providing behavioral health care services — it includes social services to tackle food security, employment, housing, violence, immigration status, legal problems, and financial needs.

California by the Numbers

California Mental Health and Substance Use Disorder Treatment

The Centers for Disease Control and Prevention (CDC) also points to the integration of behavioral health into primary care practice as a strategy for improving mental health and reducing drug and alcohol use.

The multipronged approach of including mental health and substance use screenings and treatment in primary health care involves a team of primary care physicians, social work case managers or behavioral health consultants, and mental health specialists who coordinate their practices to decrease disparities in care stemming from social issues that result in barriers to mental health care and addiction treatment.

Mental health disorders and substance use disorders (SUDs) frequently occur together, and simultaneous treatment is needed for successful recovery. Stigma and a lack of understanding of these chronic diseases exacerbate current issues in mental health social work and complicate matters for vulnerable Californians who need help.

In fact, in 2018, Governor Gavin Newsom wrote “As a mayor, I was acutely aware of the many ways untreated mental illness tore at the fabric of community.”

Vowing to pursue an aggressive agenda on mental health care that included research and prevention, he noted that a third of San Francisco’s 7,500 homeless were suffering from untreated mental illness and that the state’s jails were serving as “de facto asylums.”

The CalMatters report noted that more than 30 percent of California prisoners were receiving treatment for a severe mental disorder at the time of publication.

From the 2004 Mental Health Services Act, which enacted a 1 percent tax on millionaires to administer programs that emphasized “client-centered, family focused and community-based services that are culturally and linguistically competent and are provided in an integrated services system,” to the 2018 No Place Like Home Act, which permitted the state to borrow $2 billion for affordable housing with on-site social and mental health services, California has continually sought and piloted remedies for the mental health crisis that rely on the specialized skills of social work professionals in various settings.

Mental health and substance abuse social workers are in demand among the following service providers:

Culturally competent mental health social workers contribute to these organizations and others as California revolutionizes its health care system to achieve health equity and people-centered care for all Californians delivered by value-driven, engaged, and highly qualified workforce.

Examples of Mental Health and Substance Use Disorder Programs and Initiatives

The California Health Care Foundation

CalAIM (California Advancing and Innovating Medi-Cal)

California Improvement Network

Healthforce Center at UCSF

Whole Person Care (WPC)

Los Angeles County Department of Mental Health – Hollywood 2.0

Law Enforcement Assisted Diversion (LEAD)

These programs and services represent a mere fraction of the career opportunities for mental health and substance abuse social workers in California. Harm reduction and diversion programs for people who use drugs, HIV prevention plans, public defender representation of clients with mental illness, and many other mental health- and addiction-based strategies require social work interventions.

healthcare professionals with pieces of the puzzle

California Laws Governing Mental Health and Addiction Treatment

Social workers who practice in mental health and substance abuse settings must understand the laws and regulations that govern these areas.

Licensing and Certification

California has stringent licensing and certification requirements for mental health and substance abuse social work practitioners. The California Board of Behavioral Sciences oversees licensure for LCSWs and other social work standards.

Confidentiality Laws

Protecting the privacy of individuals seeking mental health and substance abuse treatment is paramount. Social workers must adhere to strict confidentiality laws, such as the Health Insurance Portability and Accountability Act (HIPAA) and state-specific regulations, such as the Confidentiality of Medical Information Act (CMIA). Understanding these laws is essential for maintaining trust with clients and fostering a safe therapeutic environment.

Involuntary Treatment

Laws surrounding involuntary treatment in California are changing. In October 2023, Governor Newsom signed Senate Bill 43, which loosened regulations imposed by the 1967 Lanterman-Petris-Short Act, expanding the definition of “gravely disabled” to include people with a severe substance use disorder, or a co-occurring mental health disorder and a severe substance use disorder.

Newsom’s Community Assistance, Recovery, and Empowerment (CARE) Court was signed into law in September 2022 and implemented in the pilot counties of San Francisco, San Diego, Orange, Riverside, Stanislaus, Tuolumne, and Glenn a year later.

Care Courts, which allow for court-ordered treatment plans for people with untreated schizophrenia spectrum or another psychotic disorder, and the reformed Lanterman-Petris-Short Act face criticism over civil rights concerns, so health care social workers need to monitor these laws to ensure that they remain in compliance.


State laws designed to protect Californians from discrimination based on physical and mental disabilities include the California Fair Employment and Housing Act (FEHA), the Unruh Civil Rights Act, and the Disabled Persons Act.

What Do Social Workers Do for People with Mental Health Disorders and Substance Use Disorders?

Dr. Jagruti Shukla, the Los Angeles County director for primary care reiterates the need for social services and social work interventions that address mental health disorders and drug or alcohol dependence.

“We know the patient has diabetes, we are trained to treat them,” Shukla told CalMatters. “But when they are street homeless, they have alcohol addiction, they haven’t eaten in two days…the conversation never moves to health.”

Social workers help in these areas by addressing the psychosocial aspects of addiction, helping clients build coping skills and navigate social challenges. Through interviews, observations, and collaboration with other health care professionals, they apply relevant social work theories and practice models to provide clients with therapeutic interventions and support services and connect them with the appropriate community resources.


Is there a demand for mental health and substance abuse social workers in California?

Yes! Governor Newsom’s mental health care reform — bolstered by recent poll results from the Public Policy Institute of California that revealed 87 percent of Californians believe the United States is facing a mental health crisis — is refocusing “billions of dollars in existing funds to prioritize Californians with the deepest mental health needs, living in encampments, or suffering the worst substance use issues.”

At least $5.1 billion will go toward building a culturally competent health care workforce to provide integrated health care that encompasses physical and behavioral health care and critical wraparound social support services to target the most vulnerable communities and save lives.

How can I become a mental health or substance abuse social worker in California?

To become a mental health and substance abuse social worker in California you’ll need a bachelor’s degree at minimum.

For advanced social work practice, you must have a master’s degree in social work from an accredited program, 3,000 supervised hours in the field, and — for social workers who want the authority to diagnose and provide advanced treatments for mental health conditions — a professional license.

In California, the only professional social work license is the licensed clinical social work (LCSW) designation.

How much can I earn as a California mental health or substance abuse social worker?

According to the U.S. Bureau of Labor statistics, mental health and substance abuse social workers in California earn an average of $81,720 a year. These are some of the highest salaries in the nation for social workers specializing in this area, and social work professionals who hold an MSW, salaries can reach up to $130,000 a year.

2022 US Bureau of Labor Statistics job market trends and salary figures for child, family, and school social workers, healthcare social workers, mental health and substance abuse social workers, and social workers (all other) are based on national data, not school-specific information. Conditions in your area may vary. Data accessed December 2023.

Discover more about other social work specializations in California.