The four reasons are as follows: 1) data are insufficient to identify the target population and to inform efforts to develop a system-wide response; 2) program design and implementation have not been proven effective by evaluation research; 3) the initiatives have been on a small scale; and 4) the impact of the initiatives implemented have not been tracked by evaluation research. Following the analysis of these reasons for failure to significantly reduce the percentage of mentally ill jail inmates, this paper poses six questions that should be addressed by county leaders in their efforts to reduce the percentage of mentally ill inmates in their jails. First, is our leadership committed? Second, do we conduct timely screening and assessments? Third, do we have baseline data? Fourth, have we conducted a comprehensive process analysis and inventory of services? Fifth, have we prioritized policy, practice, and funding improvements? Sixth, do we track progress? Few counties have taken the steps necessary to answer all these questions affirmatively. The issues involved are complex and resources are limited, but progress can be made in addressing the needs of justice-involved mentally ill individuals. It requires that elected officials, criminal justice leaders, and leaders in the provision of community mental health services cooperate in the development of an infrastructure that significantly reduces the incarceration of mentally ill persons while expanding their access to mental health services.