The new century has ushered new innovations in mental health care in Belgian jails and prisons, following a century of inaction and neglect. Despite repeated pleas by several leading Belgian forensic psychiatrists, the political authorities did not see through the necessary reforms in order to bridge the severe gap between regular psychiatric care and penitentiary forensic psychiatric care. The primary reason for this situation is that, despite an extensive public health system, Belgium has not extended equitable care to prisoners. It remains the responsibility of the Justice Department to organize health care within jails and prisons but it never assumed this duty at an acceptable level; consequently, there is no quality control of the somatic or psychiatric care in jails and prisons.

A second reason for the comparatively low level of medical care in the Belgian penitentiaries is chronic overcrowding. Additionally, most prisons and jails were constructed in the nineteenth century. Modernization of the outdated infrastructure is too slow and insufficient. The European Committee for the Prevention of Torture and Inhumane or Degrading Treatment or Punishment (CPT) of the Council of Europe has repeatedly condemned Belgium for the confinement conditions of prisoners and the lack of quality of medical care inside jails and prisons (CPT-report on Belgium 2010). The Belgian government decided in 2009 to build several new prisons and a brand new penitentiary medical facility but it will take at least a decade to complete.

Following the arrest in the mid-nineties of a highly publicized case of a serial murderer and rapist, the Belgian public was shocked. This rather exceptional criminal case (Marc Dutroux) did initiate several new laws and developments in the organization of Belgian forensic care. The aims were: harsher punishment of sexual offenders, better protection of victims, and – last but not least – to develop a forensic pathway to control and treat sexual as well as mentally disturbed offenders. Concrete examples of the new trend are: the creation of specialized community treatment units for the treatment of released sex offenders (Agreement of cooperation between the federal state and the regional communities regarding the treatment of sexual abusers was approved by the federal laws of May 4, 1999, and March 12, 2000) and the building of two high security forensic hospitals in Belgium (Ghent and Antwerp). However, another important law of January 2005 is of note confirming the legal right of detainees to health care of the same quality as health care in the community (Belgisch Staatsblad 2005). This Law on Prisons and Prisoners’ Rights (LPPR) is widely recognized as a milestone in Belgian penitentiary history (Verbruggen et al. 2008).