Mary Scott Hodgin: A heads up before we get going. This is a grown-up story about prison. It describes violent acts including sexual assault. This episode also discusses self-harm and suicide. It's not for kids and it may not be for all adult listeners. 

A federal lawsuit filed in 2020 focuses on violence and sexual assault inside Alabama’s prisons for men. That case could eventually lead to federal oversight of the state’s prisons. 

But the thing is, Alabama is already under federal court order to fix its prison conditions. 

That’s because of another lawsuit filed years ago criticizing mental health care for people in prison.

The case first went to trial in 2016. 

Jamie Lee Wallace was the first person to testify.

At the time, Wallace was incarcerated at Donaldson Correctional Facility, living in a unit for people with serious mental illness. 

These are voice actors reading from a court transcript. 

Lisa Borden voice actor: Good morning. Can you tell the Court your full name, please?

Jamie Wallace voice actor: Jamie Lee Wallace

Mary Scott Hodgin: Lisa Borden is one of the lawyers who represented Wallace and other Alabama inmates.

Lisa Borden voice actor: How old were you when you first had some mental health treatment?

Jamie Wallace voice actor: Six years old.

Mary Scott Hodgin: Jamie Wallace was serving a 25-year sentence for murder and attempted murder. 

In 2009, he shot and killed his mom at their home in Graysville, Alabama.  

On the witness stand, Wallace described having several mental illnesses. He told his lawyer sometimes he hears things and sees things that aren’t there. 

Lisa Borden voice actor: When you hear things, tell me what you hear.

Jamie Wallace voice actor: Basically, my mama.

Lisa Borden voice actor: You hear your mom?

Jamie Wallace voice actor: Yes, ma'am.

Lisa Borden voice actor: Okay. Does hearing voices ever cause you to do anything?

Jamie Wallace voice actor: Yes, ma'am. It causes me to cut myself.

Mary Scott Hodgin: Ten days after this testimony, Jamie Wallace was dead. He killed himself inside a prison cell. 

Jamie Wallace is one of the incarcerated men who sued Alabama’s corrections department and its former commissioner, Jeff Dunn, in the case that came to be known as Braggs versus Dunn. Edward Braggs was another plaintiff named in the lawsuit.

The men say Alabama’s prison system is violating their constitutional rights by failing to provide adequate mental health care. Prison officials disagree. 

It’s a legal battle that’s been going on for nearly eight years. And it could be a preview of what’s to come as Alabama begins another battle in federal court.

From WBHM in Birmingham, this is Deliberate Indifference: the story of Alabama’s prison crisis and the people inside it. 

I’m Mary Scott Hodgin. 

In this episode, we hear what it’s like to be locked up in Alabama with a mental illness. And whether this lawsuit will change things.  

PART ONE

Terra Griffin has spent her career, more than 20 years, working in mental health care. 

Terra Griffin: I'm a licensed professional counselor, supervisor. And worked in various settings from school counseling to private practice, which is what I'm doing now and everything in between.

Mary Scott Hodgin: In the summer of 2018, Griffin started working as a mental health supervisor inside Alabama’s prisons. She says the benefits were not as good as her hospital position. But she was excited to get the job. 

Terra Griffin: This was something that I had always wanted to do and really felt like I needed to do it. And so I did. 

Mary Scott Hodgin: She worked for a company called Wexford Health Sources. It’s the private company that provides mental health and medical care inside Alabama’s prisons.

Griffin worked at Donaldson Correctional Facility. It’s one of two prisons for men that’s considered a “treatment hub.”

Terra Griffin: Basically what that means, it's like they have the mental health hospitals within a prison. Basically is what that is, just to keep it simple. 

Mary Scott Hodgin: While it’s not an actual hospital, in those facilities, men can receive mental health care in Residential Treatment Units or RTU’s. 

These units are designed to provide a more “therapeutic environment” and recent court rulings specify they should offer more counseling, programming and observation for people in prison with serious mental illness.

Terra Griffin: So that's your categories of like, the psychosis and major depression and bipolar types of disorders. And so there is a separate mental health unit, mental health cells where they are, you know, where they live. And it's supposed to be for a specific amount of time. Well, we'll just say until they get well, until they're well enough to go back into general population and sometimes that’s quickly and sometimes it's not. So some of the guys have been there for a while because they're just so sick that they it's not safe for them to be in general population.

Mary Scott Hodgin: One of the treatment hubs, a men’s prison called Bullock, also has a stabilization unit. It provides the highest level of mental health care in Alabama’s prison system. Men are supposed to stay there for a short period of time to receive more therapy and close observation. 

According to court documents, the mental health units at Donaldson and Bullock prisons can house roughly 400 men in total. That’s just a fraction of the prison system’s mental health caseload. 

As of late 2021, Alabama prison officials say about 4,500 people, about a quarter of the prison population, have some kind of mental health need and receive counseling or medication. And most of those patients live in the general prison population.

They’re supposed to go to a different part of the prison to get medication or see a counselor, but space and staff are limited. 

Terra Griffin says when she worked at Donaldson counseling sessions sometimes happened in the hallway or standing outside of cell doors. 

She says it was normal for counselors to be caring for anywhere from 75 to 100 patients.

Griffin ended up leaving the job after about a year. She says the work was grueling.

Terra Griffin: I'm sitting here as I'm talking to you now, and I'm thinking, “Oh, my gosh. How did we do that?” And I mean, it's easy, right, to run a hospital. But to run a hospital within prison walls is where it gets complicated. So. You can't do your job as well as you would like to or want to or need to, because there's, because you're doing it in a prison, because there are so many restrictions, because there are so many things going on. I mean, you know, and in the prison safety is first. I get it, I want to be safe. I don’t ever want them to waver on that, or never wanted them to waver on that. But in the midst of maintaining safety, just like we know how to prioritize health issues, we have to do the same thing with mental health issues because an untreated mental health issue leads to death just like cancer does.

Mary Scott Hodgin: By the time Terra Griffin started working at Donaldson Prison, the Braggs versus Dunn lawsuit was well underway. 

The judge overseeing the case, Federal Judge Myron Thompson, issued one of his first major opinions in the case in 2017. It was more than 300 pages long. 

In it, Thompson says mental health care in Alabama’s prisons is “horrendously inadequate.” And he says the “inadequacies” start at the door.

He says the Alabama Department of Corrections does not properly identify people with mental health needs. And when a need is identified, Thompson writes that prisoners receive “significantly inadequate care.” 

Judge Thompson says Alabama does not do enough to prevent the “worst possible outcome in mental-health care,” suicide. 

The judge cites many stories of people who were not getting the treatment they needed inside prison, including Jamie Wallace, the first witness to testify in the trial. The man who killed himself 10 days later.
Judge Thompson writes, “Without question, Wallace’s testimony and the tragic event that followed darkly draped all the subsequent testimony like a pall.”

Dozens of attorneys have represented inmates in the Braggs versus Dunn lawsuit. Lawyers with the Southern Poverty Law Center, the Alabama Disabilities Advocacy Program and private firms. 

Lisa Borden joined the team in 2016, shortly before testimony began. 

Lisa Borden: Once I got involved in the case, it was decided that I would be the person who would put Jamie on the stand at trial. And so I did spend a lot of time with Jamie getting to know him, you know, preparing his testimony, answering his questions.

Mary Scott Hodgin: According to court records, Wallace had been diagnosed with bipolar disorder, schizophrenia, an intellectual disability, and “substantial physical disabilities.” 

During his testimony, Wallace talked about cutting himself and being punished for it. 

He said he didn’t see a mental health counselor as often as he wanted to. He described being threatened by correctional officers and being made fun of by other men in prison. 

Lisa Borden says Jamie Wallace needed hospital level care. Instead, most of the time, he was housed in the residential treatment unit or RTU at Donaldson Prison. And when he threatened suicide, Wallace would often be sent to one of the unit’s suicide watch cells.

Lisa Borden: I'll tell you, there was a point in the trial where the court did some site visits. And so Judge Thompson went and visited some of these places and he went to the RTU at Donaldson. And one of the things he saw there was the cell where Jamie had been held during some of his suicide watch episodes.

Mary Scott Hodgin: Borden says the cell was behind a staircase. It had a solid steel door with a small window that was difficult to see through. 

Lisa Borden: We walked into the cell and it was one of the most depressing, demoralizing places you could ever be. It was filthy. There was feces smeared on the wall, you know. They sleep on a concrete block and are given a little thin mat to throw on top of this concrete block. To think about somebody who, who hears voices and is, you know, thinking about taking his life most of the time. And this is where they put him. 

Mary Scott Hodgin: In his ruling, Judge Thompson describes visiting the mental health units at Donaldson and Bullock. He says “the majority of prisoners in those units were lying in their cells, often in a fetal position and facing the wall.” 

The judge also describes visiting segregation units at several facilities. These are isolation cells where men are typically locked up for 23 hours a day or more, usually for punishment, sometimes for protection.

The difference between these housing units is important. And it can get confusing. 

Segregation, which is also referred to as restrictive housing, lockup, or solitary, is basically for anyone. People might stay there, alone or with another person, for weeks, months, even years.

That’s different from a “crisis cell” or a “suicide watch cell,” which are supposed to be “suicide proof.” People on suicide watch are only allowed a blanket and a smock. Regulations call for near-constant observation.  And people are not supposed to stay in a crisis cell for longer than 3 days.

But according to court documents, prison officials don’t always follow protocol. Men without diagnosed mental health needs are sometimes sent to mental health units due to a lack of space. People who should be on suicide watch are sometimes sent to segregation cells. 

Judge Thompson specifically addressed this issue. And the state agreed, in the long term, to stop housing people with serious mental illness in segregation.

After Jamie Wallace testified at trial, he spent 10 days in the stabilization unit at Bullock Prison. 

Court records show Wallace was mostly alone in his cell. He had no group activities in those last days because there were not enough guards to do them safely.

Lisa Borden says that isolation was extremely difficult for Jamie Wallace. 

Lisa Borden: He was very personable. He loved to be around people and to talk to people. And, you know, as it turned out, the failure of ADOC to facilitate that in any way, in my opinion, is what killed him. 

Mary Scott Hodgin: Officials with Alabama’s prison system say they did provide adequate care to Jamie Wallace. 

Bill Lunsford is the state’s lead attorney. He’s represented Alabama in the Braggs case since it started almost eight years ago. 

Bill Lunsford: I cannot imagine a more tragic story than Jamie Wallace. There was not a person in the courtroom who was not adversely affected by his death. There are things we forget about Jamie. I mean, just a tortured personal history that you would not want any human being to endure in terms of his personal history. We had successfully prevented him from committing suicide 60 times, I believe. And that doesn't count the number of times that he had engaged in superficial self-injury. He was very mentally ill. 

Mary Scott Hodgin: Lisa Borden says the failures in Jamie Wallace’s case started before he ever got to prison. 

She says, for years, Wallace’s family tried to get him stable help for his mental illnesses. Just weeks before he shot and killed his mother, Wallace had been released from a psychiatric facility and was prescribed new medication. 

Lisa Borden: It just blows my mind, you know. He shouldn't have been in prison. He should have been in a hospital, and if we had the kind of mental health care in the community that we ought to have and are supposed to have, then somebody would have been keeping an eye on what was going on with him when he was released from the hospital on new medication. And, you know, his mother might be alive today. 

Mary Scott Hodgin: Across the nation, prisons and jails are considered to be the biggest providers of mental health care.  

It hasn’t always been that way. 

Until just a few decades ago, many people with serious mental illness were housed in overcrowded asylums.

There were reports of abuse and neglect. People living in horrible conditions with little or no treatment. 

It sparked a wave of lawsuits. A note here that the following video clip uses language now considered offensive. 

News Clip: Over the years there’ve been horror stories all over the country about the way the mentally retarded are cared for. 

Mary Scott Hodgin: This is a national news report from 1972. About a case that started in Alabama. 

News Clip: Now in Alabama, a federal judge, Frank Johnson, has ruled for the first time that state officials have a constitutional responsibility to take proper care of those confined in mental institutions. 

Mary Scott Hodgin: Federal Judge Frank Johnson is the same judge who a few years later would place Alabama’s prison system under federal oversight. We talked all about that in our second episode. 

But before that, in the early ‘70s, was the case that took on Alabama’s mental health institutions. It was one of several major cases during the 1960s and 70s that dealt with treating and protecting the rights of people with mental illness. 

President John F. Kennedy: With respect to mental illness, our chief aim is to get people out of state custodial institutions and back into their communities and homes without hardship or danger. 

Mary Scott Hodgin: This is President John F. Kennedy talking about the Community Mental Health Act, which passed in 1963. The goal was to move people out of large hospitals and into community-based treatment. This is often referred to as “deinstitutionalization.” 

Treatment advocates say it was a good idea, but it didn’t roll out as planned. States didn’t invest enough in outpatient care.

At the same time, they cut funding for large mental health facilities.

As the country closed hospitals, it built prisons. 

In Alabama, data from the early 2000s show that people with mental illness are four times more likely to be incarcerated than hospitalized. 

Alisa Roth is a reporter who’s studied this. She wrote a book called Insane: America’s Criminal Treatment of Mental Illness. 

Roth says looking back, you have to be careful when connecting the dots. 

Alisa Roth: The story that people like to tell is that we had these institutions where all of our people with mental illness lived. Then back in the 50s and 60s, we shut down those institutions and suddenly everybody was out on the street. They weren’t getting mental health care. They committed crimes. And they ended up in jail or prison. But there’s a number of problems with this tidy story that we tell about the closing of institutions.  

Mary Scott Hodgin: To start, she says it’s important to remember that the United States has never had a robust or equitable mental health care system. 

Alisa Roth: Jail and prison has always been a default landing place for people with mental illness that we, that we didn’t know what to do with. 

Mary Scott Hodgin: The number of people with mental illness in our prisons and jails has increased significantly in recent decades. But Roth says it’s not just because states closed institutions. It also has to do with what we talked about in episode 3. States adopted harsh sentencing laws and started arresting more people. 

Roth says there are factors that can make people with mental illness more vulnerable to getting caught in the system like criminalizing drugs. 

Alisa Roth: When we look at people in prison and jail who have a mental illness, a large percentage of them have a co-occuring substance use disorder. So if we’re going around arresting and then locking up somebody because they were using drugs, possessing drugs, selling drugs, it then stands to reason that, again, you’re going to be sweeping up more people with mental illness. 

Mary Scott Hodgin: Roth says another thing to keep in mind is that people with mental illness don’t always behave in ways that are considered socially acceptable. They may not know how to interact with police or follow commands. And if police feel that someone’s behavior is a threat to themselves or others, they often have few options but to arrest them. 

Alisa Roth: So there’s really a lot of ways that people are ending up in the system and getting stuck in the system. And I think the sort of larger question is “why is it this system that’s responding to the mental illness or the substance use, rather than a more appropriate way of dealing with the problem?”

Mary Scott Hodgin: It’s a question that came up for Jeff Dunn while he served as commissioner of the Alabama Department of Corrections. 

Dunn oversaw the department from 2015 until the end of 2021. 

Jeff Dunn: If the broader society is grappling and struggling with a particular issue, in this case, mental health, then the likelihood is that that same issue is going to be brought into a prison system but just on steroids. And so there's a lot of statistics out there about states, prison systems being the largest provider of mental health services and things like that. And that's certainly true in the state of Alabama.

Mary Scott Hodgin: But Dunn says prisons are not designed to provide mental health care. 

Jeff Dunn: We are required to and nobody debates that, and it's desperately needed. I mean, I interact occasionally with inmates that are, that are facing these types of things. And they're human beings, too. And they need treatment and we seek to provide it for them. But it is an enormous challenge because the prison environment, the prison system by nature, is not designed to be a clinical or the type of environment if you were a mental health professional, you are going to design to help someone get better. 

Mary Scott Hodgin: After a break, how Alabama prison officials tried and failed to prevent more suicides.

You're listening to Deliberate Indifference from WBHM in Birmingham. 

PART TWO

Mary Scott Hodgin: This is a grown-up story about prison. It describes violent acts including sexual assault. This episode also discusses self-harm and suicide. It's not for kids and it may not be for all adult listeners. 

This is Deliberate Indifference. I’m Mary Scott Hodgin.

In the United States, incarcerated people are some of the only people guaranteed a right to medical care. This comes from a 1976 Supreme Court ruling. 

Justice Thurgood Marshall: In an opinion filed with the Clerk today…

Mary Scott Hodgin: This is Justice Thurgood Marshall reading the court’s opinion. 

Justice Thurgood Marshall: ...requires prisoners be provided with medical care and that deliberate indifference by prison personnel to a prisoner’s serious illness or injury violates the Eighth Amendment.

Mary Scott Hodgin: The legal standard is that state officials have to provide minimally adequate care to the people they lock up.  

In Braggs versus Dunn, men imprisoned in Alabama filed a lawsuit because they said their state was not meeting this standard.

In 2017, Judge Myron Thompson agreed. He said mental health care in Alabama prisons was “horrendously inadequate.”

Thompson ordered prison officials to increase staffing and better screen inmates for mental health needs. He ordered Alabama to stop using segregation cells for people with serious mental illness. The judge ordered an increase in group activities and time spent outside of cells.

Soon after this ruling, the Alabama Department of Corrections brought in a new mental health care provider for its prison system, Wexford Health Sources. I requested an interview with Wexford’s leadership. They declined to talk, citing ongoing litigation.

Some former employees say the court ruling that was designed to improve care for inmates, created frustration for staff.

Elizabeth Sturdivant: I say this, the employees of Department of Corrections were put in in the middle of a situation between the governor's office and the feds.

Mary Scott Hodgin: Elizabeth Sturdivant was a mental health counselor with Wexford for about a year from 2018 to 2019. She worked at Donaldson Prison. 

Elizabeth Sturdivant: It was so many changes. There was a whole bunch of changes that just didn't make any sense. 

Mary Scott Hodgin: She says some changes were good. New cell doors with bigger windows, meant staff could better observe men on suicide watch, seeing clearly through the glass.

But Sturdivant says many changes were not even possible due to limited resources and staff. 

Elizabeth Sturdivant: So a lot of stuff gets, to put it, to put it nicely, half assed. Because you can't do it fully if you don't put the things in place that need to be put in place, like electronic medical records, that needs to be put in place.

Mary Scott Hodgin: Sturdivant’s supervisor at Donaldson Prison was Terra Griffin, who we met earlier. Griffin says the court rulings often made her job more difficult. 

Terra Griffin: Every time something was decided in the courts, it was immediately translated or relayed to us.

Mary Scott Hodgin: For example, Griffin says she was asked to buy new therapeutic chairs, special chairs that men can be chained to when they receive therapy. But Griffin says she wasn’t told how to buy the chairs or what budget they came from.  

She says the mental health team was ordered to do more group activities, like music and art therapy. They were told to keep men out of their cells for longer periods of time. 

Terra Griffin: And so all these things were being increased compared to what had been done prior to Braggs versus Dunn. And when I say increase, I mean significantly increase, like going from coming out of the cell one hour a day to coming out of cell six hours a day. 

Mary Scott Hodgin: Griffin says there was a big disconnect between the requirements from court orders and what was possible with limited prison staff. 

Terra Griffin: The court case people are making these decisions but I don’t think anyone has a really good picture of what’s really happening and what are the resources that we’re working with. So I want to be clear. It is important that these men and women come out of these cells and have the time out and get the services that they need. But we have to make it practical, realistic and attainable. And if you want these amount of hours and you want these things done, then you've got to give the resources to make it happen. And that's where they fail. 

Mary Scott Hodgin: The point of Judge Thompson’s 2017 order was to improve mental health care for people incarcerated in Alabama’s prisons.

But the next year, suicides increased.  

Fifteen men killed themselves in 15 months. 

And that led to another ruling from the judge. 

In it, he details the deaths of the 15 men. 

Roderick Abrams was Mary Abrams’ only son.

Mary Abrams: He was a healthy little boy, healthy baby. Had no problems with him at all through birth and coming up. But as he grew, we started noticing that Roderick was a little slow. 

Mary Scott Hodgin: Abrams says when her son was in the third grade, he was diagnosed with a learning disability and ADHD, attention deficit hyperactivity disorder. 

She took him to a counselor, signed him up for mental health care. 

Abrams says in middle school, her son started getting in trouble, hanging out with a different of group of kids. 

Mary Abrams: Something just wasn't right, that I knew was there but I just couldn’t put my hand on it at the time. 

Mary Scott Hodgin: Her son spent time in several mental health facilities. He was prescribed medication, but Abrams says he didn’t like to take it. 

Abrams says when her son was 17, he had a brain aneurysm and almost died.

Mary Abrams: Yes, his personality changed. He was, you know, feeling like that self-conscious feeling and stuff like that. And I always talked to him to let him know “you're not the only one, you know. Just do the best you can. Don't think bad of yourself all the time.” Excuse me. And just tried to encourage him, as a mother should. 

Mary Scott Hodgin: When he was 20, her son Roderick Abrams was convicted of receiving stolen property and 3rd degree burglary. He served time and was released. 

Then in 2004, Roderick Abrams was convicted of capital murder. He was sentenced to life without parole. 

Mary Abrams says over the years, her son told her about being assaulted in prison. 

Mary Abrams: Oh, a great deal. It wasn't Roderick anymore. It wasn't him. I seen a big change in my son. From being beaten, stabbed. 

Mary Scott Hodgin: Abrams says she sent her son’s medical and mental health history to the warden and the chaplain. She called the prison, called prison headquarters, desperate for someone to get her son some treatment. She wanted to keep him safe.  

Mary Abrams: If my son had got the proper care that he really needed, I believe Roderick would be living today. He wanted help. He reached out for help. From Montgomery to Washington, we called, we called and we called. We didn't get any help. 

Mary Scott Hodgin: Judge Myron Thompson describes Roderick Abrams’ death in a 2019 ruling about suicide prevention. 

The judge says “rampant…failures plagued” his case. 

According to court records, Abrams did not consistently receive mental health care in prison. He had a history of using drugs.

In the months leading up to his death, Abrams was in and out of segregation. Required mental health screenings were delayed. 

Abrams told a nurse he was considering suicide. 

But many of his counseling appointments were canceled because of staffing shortages.   

Abrams had told prison staff that he’d been sexually assaulted by another man in prison. He said he was feeling “hopeless” and “fearful.”

In late December of 2018, Roderick Abrams said he was afraid to go back to his cell block. 

He was placed on suicide watch for a few days.

The day after Christmas, prison staff moved Abrams off of suicide watch. And a few days later, on January 2, 2019, prison officials say Roderick Abrams killed himself in a segregation cell at St. Clair Correctional Facility.

Roderick Abrams: Hey mom, I’m trying to call from, call you on your phone mom. Pick up. 

Mary Scott Hodgin: Mary Abrams got this voicemail from her son Roderick Abrams, the morning of his death. 

They talked later that day and she could tell something was wrong with her son. 

Mary Abrams: He started telling me on that phone. “I love you. Tell your sister, my sister. Tell Missy, Mika, 'I love them.’” He said “Momma, I love all of y'all.” He did that. And that just didn't ring a bell because he never did that. He always say, “I love you, mama. I talk to you later,” and hang up. Because he always said, “don't tell me bye.”

Mary Scott Hodgin: Mary Abrams says she and her daughters learned about Roderick's death when another inmate called them later that day. They called the prison to confirm the news. 

Ja’Mese Abrams is Roderick’s sister. 

Ja’Mese Abrams: You know, no matter how many times you call, leave a message, nobody helps. He's already feeling confined in there as it is. He'll have an issue. He'll go to somebody, ask for help. Nobody helps him. Nobody believes him. So that'll play, that'll play a part. I'll say not only the, I guess the issues that he did have as far as, you know, the fights or the, you know, people putting him down and things like that, that stuff played a part in it. I think the worst part though, was actually having to go to a funeral home and see my brother. That was the worst.

Mary Abrams: She said it all. That was the worst. 

Ja’Mese Abrams: And it left us feeling like, we, we, we as his sister and as his mom, I feel like we didn't do enough. Even though he was in there and they were supposed to provide him with those things, I feel like, we didn't do enough to help him either. That's how I feel. We were limited on the outside as well. 

Mary Abrams: We did everything we could do. I know I did. 

Mary Scott Hodgin: Mary Abrams is working with a lawyer to sue Wexford Health Sources and the Alabama Department of Corrections over her son’s death. They filed a case in 2020. 

Mary Abrams does not want other families to go through the same thing.  

Mary Abrams: That was my son. I birthed him into the world. I did everything I possibly could to get my child help, even before he got grown to even get in trouble like this. Money is not an issue. It’s the principle of how these men are being treated in these prison systems. 

Mary Scott Hodgin: Roderick Abrams killed himself in a segregation cell. That’s where most suicides happen. 

Federal Judge Myron Thompson describes these units as having “an overpowering sense of abandonment and despair.” 

Terra Griffin: Some days I just felt so helpless like I couldn't do enough.

Mary Scott Hodgin: Former mental health supervisor Terra Griffin says every day she worked inside Alabama’s prisons, she worried about suicide. 

Terra Griffin: The stress of keeping these guys alive is more intense to me and very pressure-ous for mental health staff. And so not only am I carrying that for me, but I'm carrying that for the staff, too, who are also worried and concerned about the patients that they're assigned. Right. Or even if they're not assigned like people, your heart goes out to just these men, you know, and the stress that they're in. Because at the end of the day, they're humans. They're human. So we care. That's what we care about. That's why we're in this field.

Mary Scott Hodgin: After Judge Thompson ordered Alabama to improve suicide prevention, prison officials agreed to enhance training and change procedures to better identify people at risk. 

That was in 2019. Since then, the rate of suicides has dropped. But at least a dozen more men have killed themselves inside Alabama’s prisons. 

There’s also been a “dramatic increase” in the number of men placed on suicide watch.

When she worked at Donaldson Prison, Terra Griffin says sometimes, when she was short on staff, she took shifts monitoring people on suicide watch. 

Griffin says she saw men facing different challenges.

Terra Griffin: When you have these serious mental illnesses and people commit crimes in the midst in the height of their illness, when they get cognizant again, they're haunted by their demons. I think the other thing that happens is not being able to get peace with this being the reality that the prison sentence, you know, if it's, you know, more than 10 years, then it's almost like a lifetime, even if it's not a lifetime. And then untreated mental illness, untreated, just plain old, maybe some psychosis going on and just despair. Same thing you would see out in the real world. But the despair is probably tenfold because, like we've already identified the system, the environment. It's just, it's just distressing. You know, um, I left every day and it was distressing for me. Imagine never getting to leave.

Mary Scott Hodgin: I was able to get a glimpse of mental health care in state prisons. 

When I toured Kilby Correctional Facility back in 2019, I saw the suicide watch cells there, used for men who need mental health crisis care.

Leon Bolling: We have 15 crisis cells, but with the 15 crisis cells that we have, we have to provide for other facilities. 

Mary Scott Hodgin: Leon Bolling was warden at the time. He’s since retired. 

Mary Scott Hodgin: Explain what a crisis cell is for?

Leon Bolling: For inmates saying they’re going to do self-harm to themselves, inflect injury, have suicidal thoughts and different stuff like that.

Mary Scott Hodgin: Bolling shows me the inside of a crisis cell. It’s bare bones, a metal toilet and a twin-sized mat on a metal frame. Nothing else. 

Leon Bolling: It’s a single cell, bed bolted to the floor and one mattress on the floor. Everything supposed to be free from a person being able to do something trying to harm themselves. And once this person goes on acute, says they’re suicidal or whatever, then you have to have, an observer has to sit there and monitor this inmate’s behavior around the clock til you come off acute or non acute.

Mary Scott Hodgin: Bolling says the biggest challenge with mental health care is staffing. 

He says the prison system needs more people to observe inmate behavior. It needs more correctional officers to transport men to counseling sessions. It needs more officers to protect people in prison from harm.

That’s what the federal judge says too. 

It’s been five years since Judge Myron Thompson issued his first major ruling about mental health care in the Braggs lawsuit.

He recently issued another major ruling at the very end of 2021. 

The judge says after several years of litigation, some aspects of mental healthcare in Alabama’s prisons have improved. 

Prison staff now better identify people with mental health needs. They develop treatment plans. They have a better system for suicide watch. 

But Judge Thompson says there are still “many deeply serious problems.” 

Inadequate record keeping. Not enough counseling or therapy. More mental health providers but not enough.

And above all else, Judge Thompson says there are still not enough correctional officers. He says this is the biggest problem. And as long as Alabama’s prisons remain understaffed, people with mental health needs are at “daily serious risk of deprivation, decompensation, and death.”

Officials with the Alabama Department of Corrections have appealed the recent order. They say the ruling is too broad and unreasonable. 

They argue that mental health care in state prisons is minimally adequate. The state’s appeal is now pending before the courts.  

Bill Lunsford is the state’s lead attorney. I talked to him a few months before the latest ruling came down. 

Bill Lunsford: Really, it's difficult to imagine since 2017 an area of the Department of Corrections that Commissioner Dunn and his team have not attempted to overhaul in some way.

Mary Scott Hodgin: Lunsford says in recent years, Alabama has invested millions of dollars to hire more mental health providers and improve mental health training.  

He says the state is taking steps to improve, which should satisfy the court. 

Bill Lunsford: People often characterize the Department of Corrections as a, as an institution, but I deal with people and the people that I deal with, they don't disregard anything. I mean, they are invested in this system and they're consciously making choices every day to ensure that these people are receiving every single form of mental health care or medical care that they need.

Mary Scott Hodgin: In addition to the Braggs case, Lunsford represents the state in another high-profile lawsuit filed by U.S. Justice officials. They sued Alabama in late 2020 over conditions of violence and sexual assault in its prisons for men.

Lunsford also represents other prison systems across the country. 

He says litigation is common and people often file lawsuits to spark change. But he says cases can drag on for years, and it’s expensive. 

In recent years, the Alabama Department of Corrections has spent millions on legal fees.

Bill Lunsford: In terms of institutional reform in a correctional context, which we're involved in in a number of different states, litigation is the slowest, least effective way to do it.

Mary Scott Hodgin: Alabama Lawyers who represent inmates with mental illness disagree with that assessment. 

They say litigation takes a long time, but it’s worth it because it forces change. 

Terra Griffin, the former mental health supervisor, worked in Alabama’s prison system during a time when the courts were ordering changes. And she says she did see some improvements. 

Terra Griffin: One of the things that the Dunn versus Bragg lawsuit has done that I think is amazing, is they have increased training, where mental health professionals train the security staff. 

Mary Scott Hodgin: Griffin says inside prison, there can be a disconnect between correctional officers and mental health staff. She says since officer training focuses on the potential for violence, officers look for safety threats. 

She says they often don’t know how to identify depression or psychosis. 

Terra Griffin: And one of the things that the officers used to tell me all the time is like having these conversations with mental health professionals, like being transparent with one another, telling like "I don't believe that he's ill." And me going back and saying, "well, he is. And let me tell you why he is as evidenced by these things," not just, you know, because they need to be able to see the officers do their very, you know, like show me the facts, give me the proof, which I get it right because of the way. They're training their way and I'm trained my way. And so trying to merge those two ways of thinking so that we can best serve the patient inmate.

Mary Scott Hodgin: Griffin says many of the people working inside Alabama’s prison system want things to be better. They want less violence and more programming. Mental health staff want to spend more time caring for their patients. But Griffin says that requires more people, more resources.

Terra Griffin: Truth be told, lives have been lost. Things have happened. The conditions are deplorable. It is not a lie. It is all true. But Rome wasn't built in a day. And I just don't think there is enough, like you say, empathy going on.

Mary Scott Hodgin: Since she left her job in 2019, Griffin says many of the people she worked with have also left, both mental health professionals and correctional officers. 

Because of the Braggs versus Dunn lawsuit, Alabama has been under court order for years to hire more security staff. In fact, the state was supposed to bring on more than 2,000 correctional officers by now. 

But the most recent court ruling says staffing numbers have “barely increased.” 

Alabama's prisons are still operating with fewer than half the correctional officers that they need.

The state now has until July of 2025 to meet the court-mandated staffing quota.

But current and former officers say it’s a tough job. 

H. LaMarr Clasberry: When you see on TV, this person got killed. This person got stabbed. This person is beaten up. Who in their right mind would want to work at a prison?

Mary Scott Hodgin: It’s what many call the biggest issue facing the Alabama Department of Corrections. How to hire enough correctional officers to keep people in Alabama’s prisons safe. 

Sandy Ray: You got to imagine they broke every bone in his face. Every bone. You know, I'm thinking, “Guards? They're supposed to protect him.”

Mary Scott Hodgin: That’s next time, on Deliberate Indifference. 

This is Deliberate Indifference. 

I’m Mary Scott Hodgin. I wrote and reported this episode. 

Kate Smith and Gigi Douban edited the script.

Meg Martin fact checked the episode.

Matthew Hancock created our music and served as audio engineer.

Miranda Fulmore helped with production assistance and digital material. 

Help along the way from Audrey Atikins and Andrew Yeager 

Website design by Cayenne Creative 

NPR’s Story Lab helped get this project started. Thanks to Debbie Elliott and Peter Breslow. 

And special thanks to Alberto Enes Romero.

To hear all of our episodes, subscribe wherever you get your podcasts. And be sure to check out our website for more details. That’s deliberate indifference dot org. 

Join me next time for a new episode of Deliberate Indifference.