Between them, Richard Higgins (Letters, 5 February) and Matt Muijen (Community Spirit, 22 January) pose the key questions for health service practitioners and managers. I hope some of the answers will be illuminated by direct experience of those caring for people with a mental illness.

The most productive discussion we have had locally was among the trust's maternity, community health and mental health service managers and practitioners, addressing the question: what do we do for people who have a mental illness? Our mental health clients have babies, bring up children, have elderly parents; some are homeless, some have diabetes and some even have in-growing toenails. The trust has staff skilled in each of these areas who try hard to work together, and with our local authority, sister acute trust and voluntary sector colleagues. A policy which takes us back to isolated mental health services will betray - again - all the people for whom we are trying to care.

Discussing these matters, and others, with our colleagues in the North Thames mental health service learning network has been very helpful. A consistent theme is emerging: it's not structure or configuration which makes the difference, it's the leadership.

Hilary Scott,

Chief executive,

Tower Hamlets Healthcare trust.