Cross-Cultural Mental Health Supervision: A Scoping Review through the lens of Cultural Safety and Epistemic Justice

Abstract

Cross-cultural supervision (CCS) in mental health and psychosocial support (MHPSS) services occurs when supervisors and supervisees are from different cultures or contexts. In CCS, cultural differences intersect with supervisory power asymmetries, making supervisees vulnerable to culturally unsafe supervision practices. Despite CCS becoming more common in MHPSS, there remains limited understanding of how to practice culturally safe supervision. Further, this growing literature has not been synthesised. This scoping review explores how and by whom CCS is framed, what processes are involved, and how CCS may support MHPSS services, guided by an epistemic injustice framework. The search of academic and grey literature identified 45 papers on CCS in MHPSS. Most CCS studies were based in Western Educated Industrial Rich and Democratic (WEIRD) countries and used WEIRD paradigms, raising questions about generalisability and culturally safe application of CCS in non-WEIRD contexts. Studies in WEIRD countries often framed CCS using ethnocentric language, and inconsistent terminology when discussing culture. There was also a wide range of types of cross-cultural supervisory relationships, which we conceptualised as a broad spectrum whereby supervisory relationships differ in the extent of cultural difference between supervisors and supervisees. Common factors addressed in CCS literature were supportive relational processes, challenges in communication, culturally responsive practices and power dynamics. Culturally responsive supervision occurs through supervisor cultural humility, self-reflection on power, reciprocal learning attitudes and supervisors encouraging multicultural discussions. Culturally safe supervision benefits MHPSS services through enhanced supervisee clinical skills, increasing disclosures of client case information, increasing cultural humility and adapting Western models of therapy to suit clients. Based on these findings, we recommend that researchers and practitioners: acknowledge WEIRD paradigm dominance and White normativity; seek definitional clarity of CCS concepts; initiate supervisor-led multicultural discussions that recognise power dynamics; practice cultural humility; proactively seek peer and supervisor support; prioritise locally-led supervision and education research in non-WEIRD and humanitarian settings; and develop new models of CCS processes and configurations. This review has implications for CCS practice and research, raising questions about the underrepresentation of non-WEIRD scholarship and privileging of WEIRD paradigms, and highlighting a need for development of epistemically just and culturally safe CCS models.