The digital age is upon us. Television is changing (www.digitaltelevision.gov.uk/). Freeview channels are phasing in, reducing the dominance of familiar terrestrial channels. With choice expanding, in-patient services face a novel dilemma. Should they restrict access to new and widely available explicit materials or expose patients to them as part of normalisation?

When our in-patients requested Freeview boxes in their rooms we were surprised to learn that available content includes pornography channels (for 10 minutes, or longer with a subscription) and ‘sex guides’ with graphic imagery on unrestricted channels. While many secure units ban 18-certificate films, printed pornography and unrestricted internet access, we suspect they are unaware of this new source of explicit material.

Whether pornography is harmful is controversial. It probably increases risk of sexual violence for a predisposed minority (Reference Seto, Maric and BarbareeSeto et al, 2001) likely to be over-represented in secure mental health units. Sexually misogynistic content is likely to negatively affect self-esteem and mental state of those with sexual abuse histories, also more common among individuals with mental health problems (Reference Spataro, Mullen and BurgessSpataro et al, 2004). It is accepted that access to pornography should be restricted for adolescents and children.

We are not arguing that pornography should be banned or is inherently wrong. Rather, we are concerned that it is available to vulnerable people without the awareness of professionals charged with their care. Television is changing. Our attitude must also change to ensure we are managing risks proportionately but effectively.