Alabama’s prison system appealed findings that its mental-health care was systemically inadequate and challenged a multi-part injunction requiring staffing, treatment, monitoring, and remedial reforms. The Eleventh Circuit held that the extensive trial record supported system-wide Eighth Amendment liability and that the district court’s external monitoring order satisfied the Prison Litigation Reform Act’s need-narrowness-intrusiveness requirement. It affirmed the liability and monitoring orders, affirmed most of the remedy, reversed limited provisions that exceeded the proven violation, and remanded for modification.