Purpose: The purpose of this paper is to explore non-violent pornography within secure hospital settings. Design/methodology/approach: It includes a systematic review (n = 40 papers), followed by a qualitative study comprising semi-structured interviews (n = 24, 6 patients and 18 staff) and staff focus groups (n = 22 staff). Findings: The systematic review identified six themes, as follows: pornography is inconsistently defined, pornography exposure can increase general aggression, pornography exposure may increase the risk for sexual aggression, pornography exposure can increase aggression supportive beliefs, pornography exposure impacts negatively on those with a violent predisposition and pornography is educational for men not identifying as heterosexual. The semi-structured interviews and focus groups revealed four themes as follows: staff members hold diverse beliefs about pornographic material, pornography is difficult to obtain and use for patients who do not identify as heterosexual, pornography is used for specific functions, and frequent exposure to pornography can have negative effects for staff members. Practical implications: Trying to obtain consensus on the impacts of pornography on forensic patients is not possible; material access decisions should be on a case-by-case basis. Policy decisions should be based on fully represented views, including the LGBTI community. The impacts on staff of their occupational exposure to such material should be recognised and support provided. Clinical decision-making in this area should consider not only if access should be allowed but also how it can be managed safely, if at all. This includes for all those who could be exposed to such material, inadvertently or otherwise. Originality/value: It addresses the under-researched area of patient access to pornography, capturing a poorly considered sample, namely, high secure psychiatric.