by Matt Clarke

On June 24, 2026, the United States Court of Appeals for the Eleventh Circuit upheld the vast majority of the relief granted in a lawsuit challenging the unconstitutionally inadequate provision of mental health care in prisons operated by the Alabama Department of Corrections (DOC).

This is a class-action federal civil rights lawsuit over unconstitutionally inadequate mental health care in the DOC that has been litigated for a dozen years, as PLN has reported. After numerous hearings and a seven-day bench trial, the district court issued an opinion finding DOC liable. See: Braggs v. Dunn, 257 F.Supp.3d 1171 (M.D. Ala. 2017). [See also: PLN, Nov. 2017, p.28.] Due to the complexity of the issues, the Court divided the remedies into three phases. The parties negotiated and eventually reached a series of agreements regarding remedies for the DOC’s Eighth Amendment violations. Following seven more days of hearings, the Court issued its Omnibus Remedial Opinion and Omnibus Remedial Order for Phase 2A. See: Braggs v. Dunn, 562 F.Supp.3d 1178 (M.D. Ala. 2021). [See also: PLN, Nov. 2023, p.46.]

In that document, the Court noted that the suicide rate among DOC prisoners was double that of the national average for jails and prisons and that “at least 27 more men in DOC’s custody have died by suicide” in the four years since the finding on liability.

The Court wrote:

“The common thread among these tragedies is DOC’s lack of [guards]. As its own mental health vendor has noted: ‘No one disputes that the DOC has a severe shortage of [guards] … This deficiency in [guards] is nearly unchanged in its severity and impact since the court’s liability opinion four years ago … And, as of the time of the liability trial and opinion, the lack of [guards] undermines the department’s ability to meet the mental health needs of its prisoners in numerous, insidious ways. Prisoners do not receive adequate treatment and out-of-cell time because of insufficient security staff to supervise these activities. They are robbed of opportunities for confidential counseling sessions because there are too few staff to escort them to treatment, forcing providers to hold sessions cell-side. They decompensate, unmonitored, in restrictive housing units, and they are left to fend for themselves in the culture of violence, easy access to drugs, and extortion that has taken root in DOC facilities in the absence of an adequate security presence. The resulting sky-high rates of suicidality divert scarce mental-health resources from treatment provision to crisis management, exacerbating the deficiencies in care.”

In the liability opinion, the Court found that DOC’s mental-health care violated the Constitution by: “(1) Failing to identify prisoners with serious mental-health needs and to classify their needs properly, (2) Failing to provide individualized treatment plans to prisoners with serious mental-health needs, (3) Failing to provide psychotherapy by qualified and properly supervised mental-health staff and with adequate frequency and sound confidentiality, (4) Providing insufficient out-of-cell time and treatment to those who need residential treatment and failing to provide hospital-level care to those who need it, (5) Failing to identify suicide risks adequately and providing inadequate treatment and monitoring to those who are suicidal, engaging in self-harm, or otherwise undergoing a mental-health crisis, (6) Imposing disciplinary sanctions on mentally ill prisoners for symptoms of their mental illness, and imposing disciplinary sanctions without regard for the impact of sanctions on prisoners’ mental-health, [and] (7) Placing seriously mentally ill prisoners in segregation without extenuating circumstances and for prolonged periods of time [and] without adequate consideration of the impact of segregation on mental health, and providing [them] inadequate treatment and monitoring.”

The Court further found that “‘persistent and severe shortages of mental health staff and [guards], combined with chronic and significant overcrowding, are the overarching issues that permeate each of the above-identified contributing factors of inadequate mental health care.’”

The Court issued numerous remedial orders, many by agreement of the parties, eventually consolidated into the omnibus remedial order. The DOC had made an “overarching proposal” for outside monitoring which the court largely adopted “in light of their own admission that they lack the capacity to self-monitor.” The Court issued a Phase 2A omnibus opinion and order for outside experts to perform monitoring and develop a monitoring plan but also train DOC personnel so that it could eventually take over monitoring. See: Braggs v. Dunn, 483 F.Supp.3d 1236 (M.D. Ala. 2020).

The remedial order addressed many issues. It required staffing levels for correctional and mental health staff to be set and filled, and mental health screening followed by appropriate treatment and housing. It also set requirements for mental health assessments, rounds and documentation. It required five hours of out-of-cell recreation per week be offered to prisoners in restrictive housing units (RHUs) and hourly RHU security checks. It required RHU and other cells to be disarmed of potential suicide tie-off points and cleaned each time a new prisoner is assigned.

The order required mental health screening by qualified personnel at intake with proper documentation and coding. It ordered timely referrals and confidentiality during counseling. It regulated treatment teams and plans. It set minimum hours for structured and unstructured out-of-cell therapeutic time according to housing. In short, the Phase 2A omnibus remedial regulated most aspects of the screening and treatment given to mentally ill DOC prisoners.

The defendants appealed the Phase 2A omnibus monitoring and remedial orders. On appeal, the plaintiffs were represented by attorneys Neal Kumar Katyal of Milbank LLC, Johannah Cassel-Walker, Jo-Ann Tamila Sugar and Catherine Emily Stetson of Hogan Lovells US, Patricia Clotfelter and William Glassell Somerville, III of Baker Donelson Caldwell Berkowitz, Montgomery’s Latasha McCrary Dejarnett, Ashley Nichole Light of CRT, and William Van Der Pol, Jr. of the University of Alabama School of Law.

The Eleventh Circuit upheld the vast majority of the orders, noting that the district court had exhaustively documented its reasoning with over 1,000 pages of liability and remedial findings. It held that the orders were appealable as permanent injunctions despite the fact that the two other phases were still pending. See: Edmo v. Corizon, Inc., 935 F.3d 783 (9th Cir. 2019).

The Court rejected the DOC’s contention that a finding that the violations were “current and ongoing” was required when the injunction was entered. This was only required when a court rejects a termination motion pursuant to 18 U.S.C. § 3626(b), not when it enters an injunction pursuant to 18 U.S.C. § 3626(a). See: Thomas v. Bryant, 614 F.3d 1288 (11th Cir. 2010).

In generally upholding the orders, the Court found that the facts “detail a prison system that failed as a whole to care for its inmates.” This was exacerbated by “severe and chronic overcrowding,” demonstrated by an occupancy rate of over 175% in 2016, and “severe understaffing of mental health providers since at least 2013” that led to the DOC’s reliance on “’unsupervised, unlicensed counselors’ known as ‘mental health professionals’ to treat inmates.”

The Court reversed relief with respect to the elimination of structural elements that facilitate suicide attempts because it was not limited to cells used to house potentially suicidal prisoners. It also exempted Tutwiler women’s prison from the orders due to lack of evidence about the prison. The remainder of the orders was upheld. See: Dunn v. Comm’r, Ala. Dept. of Corr., 179 F.4th 1277 (11th Cir. 2026).  

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