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Under the Belgian law of social defense, offenders found unfit to stand a trial are transferred to the psychiatric wards of prisons, to special high-security psychiatric hospitals, or to normal psychiatric hospitals. Belgian law sees this confinement as a way to ensure security and to give the offender access to mental health care. In reality, however, in the psychiatric wards of Belgian prisons and in the high-security psychiatric hospitals, the space given to mental health care is very problematic: services are underfunded, drug treatment is systematic, and overcrowding is often a problem. The separation between evaluation tasks and caring tasks, which has been recently enforced in some places of confinement, is a very important issue.