A recent civil grand jury report concluded that Marin’s jail had strong standards for medical care, but that the county spends too much for the services: $15,000 per inmate annually, which is about $4,000 more than the county spent a decade ago and twice what other Bay Area jails spend. Contracting with a correctional medical contractor, changing procedures for providing emergency psychiatric medication and enrolling eligible inmates in Medi-Cal could significantly reduce those costs, they said. The jury undertook the report in response to new conditions resulting from prison realignment in recent years. Local jails, typically meant to house inmates for less than a year, must now accept inmates carrying out longer sentences who would previously have gone to state prison. Marin County Jail staffers said the proportion of inmates with some form of mental illness—a big expense for the jail—has been rising; they were not sure when the rise started or the rate of increase, but about a quarter of the jail’s patients currently take medication for psychiatric ailments. A large part of the problem can be tracked to the 1950s, when California started emptying most of its psychiatric hospitals, and many of those turned out to the streets ended up incarcerated. Substance addiction is also a wide problem at the jail; one jail staffer told the jury that roughly 80 percent of inmates had substance problems. The increasing number of mentally ill patients costs the jail more money, particularly because the jail is not allowed to administer involuntary psychiatric medication; instead they send the patients to Santa Clara County, which costs $1,500 a day, in addition to transportation costs. If Marin County Psychiatric Services started to provide those services instead, and if general services were contracted out, the jury believes the county could reign in the escalating cost. The jury has asked for responses from the Board of Supervisors, the Sheriff’s Office and the director of the Department of Health and Human Services.