A Guide for Case Managers & Professionals Who Support Clients With Brain Injury
Over the last year, “Let’s Talk About Porn” has been the most popular training session I have delivered to case managers, support teams, and legal professionals.
Pornography can be an uncomfortable topic for case managers and wider professional teams to address, but discomfort does not remove the need for clear, informed and proportionate practice. Where brain injury, relationships, capacity, safeguarding, and the law intersect, pornography related concerns can become complex very quickly. What may initially present as a small or private matter can snowball quickly, raising wider questions about vulnerability, spending, consent, online behaviour, exploitation and criminal activity.
There are 3 questions we need to consider in our discussions, plans and professional documentation in relation to our clients' pornography use:
1 - Are we making lawful decisions about the client’s care and support?
Any decisions made about monitoring, restrictions, supervision, information sharing or safeguarding need to be proportionate, least restrictive, and in the client's best interest. This is where, depending on our client's age, the Mental Capacity Act, Care Act, Human Rights Act, Children Act, and Working Together to Safeguard Children statutory guidance must underpin the decisions we make and the actions we take.
2 - Are our professional boundaries clear?
Professionals can support education, safety, communication, capacity building and risk reduction, but we need to be very careful that we are not instructing or facilitating unlawful sexual activity, particularly where capacity, consent, vulnerability or a professional care role is involved.
3 - Is there any concern that our client’s behaviour may be putting them, or others, at risk of committing an offence?
Pornography use is not generally illegal, and it should not always be treated as a safeguarding issue. However, there are situations where concerns about pornography move beyond matters of preference, choice and risk, and become matters of criminal law. This is where professionals need to feel confident in knowing what to look for, and it is the focus topic of this blog post.
Pornography related concerns in relation to our clients can span several areas of criminal law. The offences most likely to be encountered by case managers involve indecent images of children, sexual communication with children, the sharing of intimate images without consent, certain extreme pornographic material, and situations involving coercion and exploitation.
Pornography and Under-18s
It is not illegal for someone under 18 to watch pornography.
It is, however, illegal for anyone to sell, share, or distribute pornography to a person under 18, including through streaming platforms, websites, and messaging apps.
This criminalises adults who share sexual material with children, and puts the onus on platforms and providers to prevent access; a responsibility that has come into sharper focus with the Online Safety Act. This legislation requires adult websites to implement robust age verification measures. Pornographic websites should now require users to upload a government ID or use facial recognition before access is granted.
While this is a step in the right direction, particularly for preventing younger children from accidentally stumbling onto explicit material, the implementation is far from perfect. With a bit of digital determination, it is still fairly easy to find unregulated, unmoderated sites. These websites have no safety checks, lots of pop-ups, and expose users to a greater risk of malware, phishing attempts and other online security risks. This raises an important concern: could age-verification barriers on mainstream platforms unintentionally be driving curious young people toward riskier, more harmful corners of the internet? Time will tell, and it will be interesting to see how Ofcom ensures consistent enforcement as the Act continues to roll out.
Sharing nude images
In UK law, anyone under 18 is classified as a child, even if they’re over the legal age of sexual consent.
This means it is a criminal offence to view, create, possess, or share any indecent image of someone under 18, even if:
- The person in the image is 16 or 17
- The image was self-generated
- The sharing happened between consenting peers
- The image was created using AI or digital editing
Here’s a tricky reality:
Two 16-year-olds can legally consent and have sex, but cannot legally share sexual images of themselves or each other. This is a grey area that can be confusing for young people, frightening for families, and complex for professionals.
It’s important to remember that the laws are designed to protect children, not punish them, but we still need to tread carefully.
If you are supporting children or teens, I recommend the UK Council for Internet Safety’s 2024 guidance: Sharing Nudes and Semi-Nudes. It’s practical, thoughtful, and highly relevant to frontline practice.
Child Sexual Abuse
Child Sexual Abuse Material (CSAM), is not pornography. It is evidence of abuse. The terminology matters, and professionals need to understand the distinction.
The Internet Watch Foundation (IWF) is the UK’s leading organisation tackling this issue. They work globally to detect and remove images and videos of child sexual abuse online, and they collaborate with tech companies and law enforcement to disrupt this content at its source.
The IWF's 2025 Annual Data & Insights Report paints a stark picture of the scale and evolving nature of online child sexual abuse:
- The IWF took action on 312,030 reports containing child sexual abuse material in 2025 (the highest number in its 30-year history), with 97% of sexual abuse material depicting girls.
- 140,276 child sexual abuse images and videos identified by the IWF were classified as "self-generated", although many of these involved grooming, coercion or extortion. Girls aged 11 to 13 are the group most commonly depicted in this class of imagery.
- Reports of sextortion involving child sexual abuse imagery increased by 127% in a single year, with boys aged 14–17 accounting for 98% of these reports.
- The IWF identified 3,440 AI-generated child sexual abuse videos in 2025, compared to just 13 the year before; an increase of more than 26,000%, with 65% of AI-generated videos categorised as Category A, the most severe classification of abuse imagery under UK law.
- The number of commercial websites selling child sexual abuse material more than doubled, increasing from 7,028 in 2024 to 15,031 in 2025.
Extreme Pornography
Not all sexually explicit content containing adults is treated equally under the law.
It is an offence to possess or distribute “extreme pornography”, defined as content that is:
“Grossly offensive, disgusting or otherwise obscene,” and that explicitly and realistically depicts:
- Life-threatening injury
- Serious injury to someone’s genitals, breasts, or anus
- Bestiality (sexual acts with animals)
- Necrophilia (sexual acts with corpses)
- Rape or assault by penetration
What’s vital to understand is this:
- Possession includes anything saved on a device, in cloud storage, on a USB drive, or printed.
- It can also include files that have been deleted, but are still recoverable.
- Distribution could be as simple as forwarding a link, posting on social media, or sharing a file with someone else.
Interestingly, viewing this type of material itself isn’t criminalised unless the material is saved, stored, or shared. That nuance is important when supporting clients. A single pop-up or accidental click may not be a criminal offence, but saving the content or sharing the content certainly could be.
Potential risks for clients with a brain injury
Exposure to pornography at a young age, particularly where a child lacks the developmental understanding to understand what they have seen, may be experienced as a traumatic event and can lead to confusion, fear, shame or distress.
Children and young people with a brain injury may also be at increased risk of:
- Being pressured, manipulated or coerced into creating or sharing nude or semi-nude images.
- Becoming victims of sextortion following the sharing of intimate images.
- Developing unrealistic beliefs about consent, relationships, body image and sexual behaviour through observational learning.
- Failing to recognise abusive, coercive or exploitative sexual behaviour.
- Sharing sexual images without understanding the legal consequences.
- Accessing illegal material without recognising that it is unlawful.
- Being targeted by offenders because of increased vulnerability, impulsivity or reduced social understanding.
- Developing unhealthy patterns of pornography use that may persist into adulthood.
- Becoming socially isolated or secretive due to pornography use, making safeguarding concerns more difficult to identify.
- Developing compulsive or habitual pornography use, particularly where self-regulation and impulse control are affected by brain injury.
As children become adults, the risk profile changes. Adults with a brain injury may continue to be victims of exploitation, but they can also be at increased risk of committing offences, because of impaired judgement, reduced inhibition, poor understanding of consent, difficulty recognising how old someone might be, limited understanding of legal consequences and a lack of adequate or meaningful relationship and sex education.
What can case managers do?
- Start early. Support families to consider rules, boundaries, and tools before a child gets their first internet-enabled device, not after concerns have emerged.
- Make sure the child has someone safe to talk to. Every child needs at least one adult who can answer the awkward questions without shame or judgement.
- Expect sexual curiosity. During puberty, sexualised behaviour and curiosity may increase. Research in this area dates quickly, but the average age children first see pornography is reported to be around 13. We should not be surprised by this, and we should therefore assume these conversations will need to happen, rather than hoping they won't.
- Make relationship and sex education part of the support plan. Many of our clients have not had adequate or meaningful Relationships and Sex Education (RSE). We cannot assume they understand consent, contraception, healthy relationships, private behaviour, image sharing, or the law. Leaving this to chance is a recipe for disaster, and sadly, it is something we see far too often in practice.
- For adult clients, keep the conversation open. Remain professionally curious about online activity, pornography use, online relationships and digital sexual expression. If you are unsure how to navigate this, seek advice from other professionals, rather than avoiding it altogether.
- Prioritise capacity building for clients who need it. This may include support to understand pornography, consent, coercion, online exploitation, image sharing, criminal risk and safer sexual expression.
- Understand the law well enough to explain the risk. If we can clearly articulate what the risk is, how serious it could be, and how likely it is, our recommendations are more likely to be proportionate and defensible.
- Do not rely on monitoring and restriction in isolation. There is so much sexually explicit content online that no app, filter or monitoring system will block all access. We need to expect exposure to pornography and plan for it. When monitoring and restriction are the only responses, we routinely see clients work around the restrictions, hide their behaviour, push back against support, and become less open with the people trying to keep them safe. In some cases, this has increased risk, caused harm and damaged relationships with families and professionals, making safeguarding even more difficult.
- Think dynamically about monitoring and restriction. For children, it is often appropriate to begin with robust monitoring and restrictions, gradually reducing these controls as the child develops the knowledge, judgement and skills to navigate the online world more independently. Where a client aged 16+ is assessed as lacking capacity in relation to aspects of their online activity, avoid blanket restrictions wherever possible. Instead, consider how monitoring and restrictions can be responsive to the client's individual risks, strengths and changing presentation, ensuring they remain proportionate and the least restrictive option.
- Think outside the box for clients who are 18+: For example, a risk-reduction approach may include considering whether subscription-based platforms can mitigate risks associated with excessive spending, unregulated material, malware, scams, excessive advertising, pop-ups, or illegal content. Equally, many clients are unaware of the wide range of legal sexual content available, including audio erotica and platforms that place greater emphasis on performer welfare, consent and representation. These conversations are not about promoting pornography, but about helping clients make safer, lawful and more informed choices.
- Your records are your friends. Keep meticulous and clear records of what has been discussed, what has been decided, what action has been taken, and why. Ensure support plans are reviewed, up to date, and reflect the expected care and support arrangements for clients' online access and activity.
If you would like advice or guidance on any of the topics discussed in this post, or would like to discuss a specific client, please get in touch with the team at access: technology by emailing domore@accesstechnology.co.uk. We would be happy to arrange a free, informal call to talk through your situation and explore next steps.