There are many identified challenges for mental healthcare services in Australia and New Zealand including design, infrastructure and workforce shortfalls. In the 2024 RANZCP Workforce Report over 75% of trainees and psychiatrists endorsed symptoms of burnout, and over 80% reported that workforce shortages contributed. There is a need for effective leadership to reform and renew healthcare services. Clinical expertise is necessary, but not sufficient for leadership of mental healthcare services through substantial cultural and organisational renewal. Expertise and prosocial skills are needed for effective cultural leadership, based upon expressed generosity and kindness that leads to a corresponding reputation that empowers cooperation. Leaders will need such skills to effect change and improve mental healthcare delivery and patient experiences.