The opening arguments today kick off the first trial in the SPLC’s broader suit, filed in federal court in 2014, alleging that the mental health and medical needs of prisoners with serious – even life-threatening conditions – are routinely ignored.

This phase of the trial is expected to last eight weeks. A separate trial on the medical issues is expected next year.

The suit describes how the lack of care from the cash-strapped, under-staffed system amounts to “deliberate indifference” by the Alabama Department of Corrections (ADOC) – a violation of the U.S. Constitution’s ban on cruel and unusual punishment.

U.S. District Judge Myron H. Thompson granted class action status to the mental health portion of the lawsuit in late November, meaning that court rulings in this phase of the case will apply to all prisoners in the system.

“Alabama’s failure to provide mental health care to the people it incarcerates puts lives at risk,” said SPLC Senior Staff Attorney Maria Morris. “This lack of treatment is inhumane and unconstitutional. No one in an Alabama prison was sentenced to this kind suffering.”

The SPLC’s investigation found severe problems throughout the prison system. Facilities where mentally ill prisoners are housed have been left to decay. The system is understaffed and uses outdated psychotropic drugs. Some prisoners with mental health problems are placed in solitary confinement and all but forgotten. Nonmedical treatment for the mentally ill is virtually non-existent.

Dr. Craig Haney, a prison expert retained by the SPLC, toured the St. Clair Correctional Facility and described the conditions in his report: “I saw prisoners living in barren ‘Suicide Watch Cells’ who had been kept there for months on end, and a prisoner residing in complete darkness, lying on an office floor in a room labeled ‘Mental Health’ and urinating in a plastic bucket.”

Dr. Kathryn Burns, a mental health expert who submitted a report on behalf of the plaintiffs in July 2016, is expected to testify on Dec. 12. Burns visited nine Alabama prisons, where she inspected crisis watch cells, observed segregation and conducted interviews. She found that the failure to provide adequate staffing levels “does not appear to be in dispute,” even by the private, for-profit company entrusted with prisoners’ mental health care, MHM Correctional Services.

When the judge certified the lawsuit as a class action last month, he noted that health practitioners have recognized that mental health care is lacking in the prison system.

“When prison mental health administrators know and communicate that they need more staff to provide appropriate care for prisoners, and the Commissioner refuses to provide funding for this staff, not in any exercise of medical judgment but because he does not have the money this suffices to establish deliberate indifference and – in conjunction with a showing that this creates a substantial risk of serious harm– to establish an Eighth Amendment violation,” Thompson wrote.

The lack of resources has led to disastrous consequences.

Joshua Dunn, a named plaintiff, was never placed on the mental health care staff’s caseload despite cutting himself on his forearm with a razor on five different occasions and asking for mental health treatment after each episode, according to the SPLC’s complaint. After each suicide attempt, the only time Dunn saw a mental health professional was on the third day of each of his stints on suicide watch. The staffer simply asked if he was still suicidal.

Another prisoner “cut herself with a razor blade she found in the suicide watch cell,” according to the SPLC’s amended complaint. Still other prisoners have been placed in segregation – despite its harmful effects on mental health patients – for as long as seven years.

Burns, the mental health expert, described the toll the prison system’s failures has taken on prisoners: “In sum, the deficiencies in ADOC … deny prisoners care for their serious mental illness leading to needless pain, suffering, self-injury, suicide and punishment for symptoms of untreated mental illness.”

The solution, according to Morris of the SPLC, is to reduce Alabama’s swollen prison population, caused by harsh sentencing policies that have given the state the third highest per-capita rate of incarceration in the country.

“Even many deeply conservative states are reducing their prison populations, making it more feasible to provide incarcerated people with the quality of care that is required under our Constitution,” she said. “Alabama must do the same.”

Earlier this year, the SPLC settled a portion of the lawsuit regarding violations of the Americans with Disabilities Act. In that settlement, the ADOC committed to provide services and fair treatment to incarcerated people with disabilities.

The lawsuit was filed in the U.S. District Court for the Middle District of Alabama. The SPLC’s co-counsel include the Alabama Disabilities Advocacy Program; Baker, Donelson, Bearman, Caldwell & Berkowitz, PC; and Zarzaur, Mujumdar and Debrosse.