"Mental health care is being modernised," the message reads. "We need to produce high quality services that treat patients and service users with dignity and recognise the commitment of families and other carers. If you or someone close to you has used mental health services, or if you work in them, please help to improve the care we provide by telling me about your ideas or experiences." The website ends: "Your message will be seen by me personally."

For those with an experience of the workings of government - particularly of an organisation as large as the NHS - this is a rare commitment. When Louis Appleby took-up his post as the Mental Health Czar in 2000, one of the first things he set-up was this website inviting people to send him their comments. "I set it up because of a fear I had that moving into government circles might mean that I lose my connection with the local clinical services. It was an opportunity for people to tell me about their concerns and to feel that they were being properly listened to and to help keep me focused on the right things."

From the beginning Appleby has received around 20-30 messages a week. "Mostly, inevitably, people write about experiences that they felt could have been better. Some of the stories are actually quite tragic, people do write to me and tell me about treatment which has been very difficult for them. Sometimes they write and tell me about a suicide in the family, so it is very moving and from my point of view absolutely - much more than I had anticipated - a vital part of helping me to do my job."

Although working in the Mental Health Service will always be a more a sensitive situation because it has powers of detention, Appleby believes that the service is "way ahead" of other specialities in the involvement of service-users in their care: "Consulting service-users is something that has being going on for years in mental health, it isn't new. It would be inconceivable now to set-up a major discussion forum or something on any kind of issue without ensuring that the service-user view is represented."

Appleby is equally forthright in his support of patient choice for the newer, more expensive, generation of medicines: "I don't need to be persuaded about the value of these drugs, I am very much a supporter of them and I am in favour of having all the best most modern treatments available to people, whether they are drug treatments or psychological treatments."

The issue is more complicated, he says, than too a narrow cost implication to society - as there is "no actual evidence" that the wider social costs improve on one type of drug or another: "But this is why it was the first issue we referred to the National Institute of Clinical Excellence (NICE). There is no question that these drugs have benefits and there is no question that, for some people, they are a better treatment than the old drugs. But we mustn't forget that they also have their side-effects."

There is also no question, he says, that there is a variation around the country in the extent to which the newer atypicals are prescribed. Appleby is proud that Manchester - where he is based - is one of the places where they are most frequently prescribed. "But when it comes to asking influencing the system as a whole, one of the best ways now to do that is to go through NICE, because what NICE says really counts," he says

"The first appraisal we presented before NICE was about typical and atypical anti-psychotics. The first guideline that we that referred to it was about the treatment for schizophrenia. So it gives you an idea of how important we think it is to get that implemented."

Appleby is also well aware of the problem of the shortage of psychiatrists: "Repeated locums create instability in the service and makes it difficult to have continuity of treatment and I do agree that is a problem. "It is true where you have got a lot of vacant posts you are a bit vulnerable to locum consultants coming in and moving around. Locums can sometimes be paid quite a lot of money and it isn't a satisfactory system that people can just simply come into a local service, work there for a while and earn quite a lot of money and then move on. And we are working towards resolving that."

The second problem, he adds, is about getting the right treatment: "Because you can have stability but you could still have the sub-optimal treatment and that in itself wouldn't be any good."

There is no question, he says, that we have some "quite serious" workforce shortages in mental health: "The consultant vacancy rates nationally run at something between 12 and 14 per cent, so it is quite a serious problem. And a huge amount of work is going into solving that: increasing training places for more junior doctors, international recruitment - the retention of junior doctors once they get into training. We have funded the Royal College to do some studies on why junior doctors choose to leave, so that we can something about that. We funded them to do a study of doctors who are thinking of retiring so that we can understand how they might be encouraged to stay."

On the BBC's Your NHS day, "more money for mental health" was voted as the eighth most important priority out of a list of 12. Was he disappointed?

"Well obviously the other priorities are important as well, so I wouldn't want to try to undermine their importance - it is a question of making sure that people think of mental health as well. I was very pleased that it was on the list and pleased that it didn't finish at the bottom of the list - I would have like it if it was a bit higher but some of the categories weren't mutually exclusive, so one of the reasons why we need more money for better mental health care is that we want to be able to have nicer wards and better settings where people can recover from illness, and more staff. So some of things that people voted for would have been helpful for mental health too."

One of the most important things that has happened in mental health in the last seven years, he says, was its inclusion as one of the three clinical priorities in the NHS Plan. "When I think back to when I was starting out in psychiatry as a junior doctor just under 20 years ago, it would have been inconceivable then that a government putting together its top priorities for the NHS would have chosen mental health. That is a fantastic step forward for us. And those kind of top level confirmations of the status of the importance of mental health do influence people, and gradually contribute to breaking down prejudice and marginalisation."

What is he most proud of?

"There is the national suicide prevention strategy which we have never had in this country before, and that is going to be launched soon. We are working on measuring mental health service performance which will make the assessment of the quality of care more relevant to both people's lives and what staff feel they do well. That will be a revolution in the system. There is the National Institute for Mental Health, which will be the main vehicle for delivering service change on the ground, and that's entirely new, so that's a very exciting development for us. And there's the £30 million for refurbishment that the government agreed to last year, which is still going into patient's wards - there has never been specific initiative like that before."

But the main thing, which he believes "has had the most profound effect", is the inclusion of mental health in the NHS Plan: "The plan was just being put together when I came into post - I would like to think that I contributed to getting mental health in it. But also into the content of it, so that in the NHS Plan we outlined new clinical services which brought with them new money. And they were quite a radical re-shaping of services to solve some of the problems that have plagued mental health care for quite a long time, strengthening community care - very much to create a modern mental health system, in the community and in wards, supporting the most vulnerable people, giving quick access to people who have got urgent needs."

The new teams and services which are coming through as a result of the NHS Plan are, he says, "very much supported" by patient and service users groups: "And I think that for me was a clear message that we have got it right in relation to solving the problems that they perceive, and that is very gratifying."

In the next few years, he says, once all of the services and changes have come through "we will have a quite different mental health service" to the one that we had when he started: "Now I don't want to claim all the credit for that but I hope that my contribution was important."