Exploring pornography use in secure hospitals: a qualitative analysis
| DOI | https://doi.org/10.1108/JFP-07-2019-0030 |
| Date | 11 November 2019 |
| Pages | 248-263 |
| Published date | 11 November 2019 |
| Author | Emily Mellor,Simon Duff |
| Subject Matter | Health & social care,Criminology & forensic psychology,Forensic practice,Sociology,Sociology of crime & law,Public policy & environmental management,Policing,Criminal justice |
Exploring pornography use in secure
hospitals: a qualitative analysis
Emily Mellor and Simon Duff
Abstract
Purpose –This research paper reports findings from a qualitative analysis which explored pornography use
in secure hospitals. The purpose of this paper is to investigate what attitudes staff working in secure hospital
have towards patients having access to pornography, how they make decisions regarding access to
pornography and what factors they take into account during this process. This research is an extension of a
prior quantitative research study (Mellor and Duff, 2019).
Design/methodology/approach –The study utilised a qualitative approach using semi-structured
interviews to explore professionals’attitudes towards pornography use in a secure hospital. The sample
comprised of six volunteers who had taken part in a previous research study (Mellor and Duff, 2019)
requesting to discuss the topic area further. As such this research study was developed. Thematic analysis
(Braun and Clarke, 2006) was used to analyse the qualitative data and the Attitudes towards Pornography
Scale (Evans-DeCicco and Cowan, 2001) was used to collect demographic information.
Findings –Six themes were identified from the transcripts. The first theme explores staff members’attitudes
towards pornography. The second relates to the use of boundaries andmonitoring of pornography. The third
theme looks at the potential impact that pornography could have on the patient, either positive or negative.
The fourth theme explores the extent to which patientsare still considered as human beings, whereas the fifth
theme explores the vulnerabilities that may make patients more at risk of being negatively influenced by
pornography. The final theme looks at decision making regarding access to pornography.
Practical implications –The research offers an insight into how pornography within secure hospitals is
managed.The research also providesan exploration into multi-disciplinaryteam decisionmaking with regard to
pornographicmaterial and notesthe general openness of staff towardspatients having accessto pornography.
Originality/value –The findings have important messages for services with regard to policy making.
The findings are also relevant for understanding how pornography is managed with in secure hospitals.
Keywords Attitudes, Staff, Decision making, Patients, Pornography, Secure hospitals
Paper type Research paper
Introduction
The availability of pornography is ever increasing (Ferguson and Hartley, 2009) and with this,
researchers have begun to consider the effects of pornography exposure. Some research
papers have reported the negative consequences of pornography, with particular focus on
sexual aggression (Marshall, 2000). As such, concerns have been raised regarding the possible
clinical issues related to pornography access in secure hospitals; predominantly those that
house sexual offenders (Mercer, 2013) who already possess sexual deviant interests. The Fallon
Inquiry (Fallon et al., 1999) brought the issue to the forefront of media attention and prompted a
thorough review of all aspects of physical and relational security within high secure hospitals
(Exworthy and Gunn, 2003). The inquiry created a sense of scandal from the general public and
perceptions of failure towards the risk management of offenders within a high security hospital.
The Fallon Inquiry (Fallon et al., 1999) stressed the importance of controlling access to
pornography as “even apparently innocuous material can have a corrupting effect on individual
patients”(recommendation 24; Fallon Inquiry, 1999, p. 42) and if not controlled could result in a
thriving trade in pornography. Furthermore, Duff (1995) invited the need for policy regarding
pornography and censorship in secure hospitals. On the other hand, mental health services have
Received 14 July 2019
Accepted 30 September 2019
Emily Mellor is based at the
Centre of Forensic and Family
Psychology, University of
Nottingham, Ningbo, China
and St Andrew’s Healthcare,
Northamptonshire, UK.
Simon Duff is based at the
Department of Forensic and
Family Psychology, Faculty of
Medicine and Health Sciences,
University of Nottingham,
Nottingham, UK.
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VOL. 21 NO. 4 2019, pp. 248-263, © Emerald Publishing Limited, ISSN 2050-8794 DOI 10.1108/JFP-07-2019-0030
seen a shift in their approach regarding the need to reduce restrictive practices and blanket rules
(Department of Health, 2014). Thus, it may be difficult to strike a balance when it comes to
pornography use. Patients residing in secure hospitals are seen to have the same needs for
intimate relationships as everyone else, thus denying access to pornography can be seen as
denying an expression of their sexuality (Perlin and Lynch, 2014).
Pornography and offending
The notion of pornography comes hand in hand with concerns around the effect this material has
on society. Despite the high volume of research, the causal link between pornography and
offending is still confusing. Cook et al. (1971) found that convicted sex offenders reported less
frequent exposure to pornography and exposure to less sexually explicit content than non-sexual
offenders.Saramago et al. (2019) found that, whilefor some individuals, pornographydid not play a
role in their offenses, there were otherswhose prolonged use led to more sexfantasies and urges
to enact the visualised contents. As such, it is still very difficult to draw firm conclusions regarding
whether this is a causallink or not. Theories such as the social learningtheory (Bandura, 1973) and
excitation transfer theory (Zillman, 1971) have been used to explain any possible link.
Policing pornography
Current policies on pornography use vary dramatically across different organisations. Such
policies often value the choice of the individual but fail to exclusively dictate the exact role of staff
who police pornography access. In turn, decision making is often left to the discretion of those
working within that service. Furthermore, there are issues regarding staff members presumably
being exposed to the pornography to determine whether it is suitable, resulting in the possibility
that they may be negatively impacted. Mercer (2011) noted that the reviewing of pornographic
material to determine its suitability often lies with nursing staff, as does the decision to restrict
such items accordingly. Given this responsibility, it is concerning that prescriptive guidelines are
not available to nursing staff to guide their decision making. On the other hand, nursing staff are
committed to providing a duty of care and ensuring positive therapeutic engagement with
offenders, where managing pornography is a daily component of care-planning and risk
assessment, for those whom it may be a risk for.
General population attitudes towards pornography
Several researchers have directly explored attitudes towards pornography with a number
of populations. Häggström-Nordin et al. (2009) explored the attitudes of Swedish students
towards pornography and found that male students reported more favourable attitudes towards
pornography than female students. Female students were more likely to report concerns that
pornography created a distorted image of sexuality than males (Häggström-Nordin et al., 2009).
Furthermore, Hald (2006) found that within a Danish sample both males and females reported
generally positive attitudes towards pornography. Research within the USA identified that most
participants felt that they had learnt about how to have sex from watching pornography, and
therefore viewed it as educational (Rothman et al., 2015).
Professionals’attitudes towards pornography
There has been some research with a focus on professionals’attitudes towards pornography
consumption. Drake (1994) noted that73 per cent of universitypsychiatric nurse educators feltthat
pornography trivialised rape and 38 per cent believed that it stimulated consumers to commit sex
crimes.However, of the 200 participants involved in the study,93 per cent were notfamiliar with the
literature related to the effects of pornography consumption. As such, it is likely that their perceptions
of pornography were based primarily on their own experiences, beliefs and moral compass
(Drake, 1994). Furthermore, this sample was a university-based sample of nurses and therefore not
directly involved with patient care on a daily basis. A qualitative exploration by Mercer (2013) noted
that male nurses were sympathetic to theneeds of the offenders toaccess pornography.However,
female nurses provided scenarios they had experienced, whereby pornography had been utilised by
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