Over the past several years, the state has experienced waitlists in county jails to transfer those deemed incompetent to stand trial (IST) to state hospitals for treatment. In response to the waitlist, which averages between 200 and 300 individuals a month, the Department of Mental Health began a pilot program in San Bernardino County to treat ISTs in county jail instead of at a state hospital. This report finds that the pilot program has greater flexibility to hold down costs and has been able to restore ISTs to competency in a shorter amount of time than state hospitals. We find that if the pilot program is expanded, it has the potential to significantly reduce the waitlist, as well as reduce costs to the public sector.