De nouveaux défis se présentent à la médecine et en particulier à la psychiatrie. Le rôle du psychiatre pourrait se transformer à l’avenir en une gestion d’équipes de santé mentale (médecins généralistes, infirmiers, psychologues, éducateurs spécialisés…). Interviennent ici les concepts de charisme et de leadership. Le charisme est « une qualité qui permet à son possesseur d’exercer un ascendant, une autorité sur un groupe ». Le leadership désigne, « la fonction, la position de chef, et par extension, une position dominante ».

Proposer quelques pistes de réflexion sur le charisme et le leadership, les moyens de les développer dans trois situations de la pratique psychiatrique au quotidien : la communication duale (entre soignants ou avec le patient), la communication orale lors d’un colloque et la gestion d’une équipe de santé mentale.

Les bases Medline et Web of science ont été explorées selon les critères PRISMA sans limite de date de publication. Le paradigme de recherche était ([psychiatrist OR physician] AND mental health AND [leadership OR charisma]).

Trente-quatre articles ont été inclus dans l’analyse qualitative. Le chef doit d’abord s’interroger sur sa vision de l’avenir, pour la transmettre avec passion à son équipe de santé mentale. Le leadership ne dépend pas de la position hiérarchique et des responsabilités administratives. Le clinicien travaillera sur les moyens de développer son charisme, par ses interactions avec ses pairs et son équipe, par l’attention apportée à son apparence et à son lieu de travail, par le renforcement positif. Il apprendra à gérer et harmoniser les différents types de personnalités au sein de son équipe en prenant particulièrement garde aux attitudes passive-agressives. Il comptera parmi ses qualités la ponctualité, la politesse, le sourire, l’auto-dérision, la régulation de ses propres émotions.

Le charisme semble être une dimension indispensable du chef qui va pouvoir mettre en place efficacement son leadership et la gestion de son équipe. Bien au-delà de la psychiatrie, ces réflexions nous semblent utiles à l’ensemble de la médecine.

New challenges arise in medicine, particularly in psychiatry. In the near future, psychiatrists’ role may evolve into management of mental health care teams (GPs, nurses, psychologists…) thus creating the need for charisma and leadership. Charisma is defined as « a quality that allows it's possessor to exercise influence, authority over a group »; leadership as « the function, the position of chief, and by extension, a dominant position ».

To offer some reflections on charisma and leadership and the ways to develop them in three situations common in clinical practice: dual communication (between caregivers or with patients), oral communication (e.g., during a symposium) and managing a mental health care team.

Medline (1966-hits) and Web of Science (1975-hits) were explored according to the PRISMA criteria. The research paradigm was [(psychiatrist OR physician) AND mental health AND (leadership OR charisma)].

Two hundred and eighty articles were found, but only 34 corresponded to our subject and were included in the qualitative analysis. The leader must first ask himself/herself about his/her vision of the future, so as to share it with passion with his/her mental health team. Charisma and leadership are based on several values, among which we can mention: providing understandable, personalized care for the patient, in continuity and confidentiality; adapting care to the general population's request, maintaining one's own physical and mental health, submitting one's daily practice to peer review, engaging in continuous improvement of one's practices in response to new requirements, and recognizing that research and instruction are part of an M.D's professional obligations. The clinician will work on ways to develop his/her own charisma, through interactions with peers and team members, the care of his/her appearance (especially for first meetings) and workplace, and through positive reinforcement (some cognitive-behavioral techniques like assertiveness have been proposed to enhance the charisma, e.g., visualization and affirmation). Leadership does not depend on hierarchical position and administrative responsibilities: leaders should learn to manage and harmonize the different types of personalities within his/her team, paying special attention to passive-aggressive attitudes. We recall here some techniques to improve charisma during oral communication, such as making relationships with people by calling them by their names, making reference to things and people that the audience can identify with (like sport or cooking), using one's own style without trying to imitate someone else, focusing on one major idea, being brief and using anecdotes, using silences effectively and finally having good non-verbal communication. The conclusion should never be neglected, as an audience especially remembers the beginning and the end of a presentation. Although some features are common to all charismatic leaders (dominance, self-confidence, high energy level), a recent theory of leadership (called contingency theory) seeks to examine how different leadership styles can adapt to circumstances. This theory focuses more on the vision, passion, determination and courage of the leader and depends not only on their intrinsic qualities. No research has indeed shown individual characteristics that differentiate leaders from followers. However, doctors have not been prepared in their training to acquire leadership skills that they can use to adapt to the circumstances of their clinical practice. The most important qualities expected of a leader according to the current leadership theorists are: listening, communication, stress management, development of other's capacities, feedback, introspection and risk taking. Moreover, leadership involves positive reinforcement of the team while maintaining the feeling of individual autonomy, and being able to take an innovative decision alone with shared optimism. There is no need to have great management responsibilities in order to succeed in leadership. We reiterate the importance for a charismatic leader to smile, to be able to mock oneself and to regulate one's emotions.

Charisma seems to be an essential dimension for effective leadership and team management. Beyond psychiatry, we believe these reflections to be useful for all branches of medicine.