He made a name for himself as the resident medium in the first 6 series of the TV programme Most Haunted, alongside its presenter, Yvette Fielding, and her specialist team of ghost hunters, which included an astrologer, an anthropologist, a parapsychologist and a medical doctor. Spending nights at stately homes and castles around Britain claimed to be haunted, they told viewers when they could feel or hear the supernatural. A popular show, it was one of the reality programmes that helped Living TV become a leading British non-terrestrial channel.
Although his credibility was questioned in 2005, when the parapsychologist Ciarán O'Keeffe, accused him of being a fake, and that he has fed him false information about spirits, he went on to star in Derek Acorah's Ghost Towns. In this show he offered private sittings to members of the public.
He has also made appearances in The Antiques Ghost Show (2003), Psychic Live (2003), Quest for Guy Fawkes (2005), Paranormal Egypt (2007), Derek Acorah (2009) and The Past Hunters (2015). In 2004, Acorah won the Variety Club of Great Britain's Multichannel TV Personality of the Year award.
After a short illness, Derek Acorah died in January 2020. He is survived by his third wife, Gwen, whom he married in 1995, and by his son, Carl, from his first marriage to Joan Hughes.