The phrase originally comes from China - Chairman Mao in his 'Great Leap Forward' advocated the training of 'barefoot doctors'; practitioners trained in basic techniques of hygiene and simple treatments who provided the only possible way of beginning to address the needs of a hard-to-reach population.

In Mental Health the situation is very different, but in some ways analogous; there are undeniably large amounts of unmet need and shortages of highly specialised staff. It is perhaps not unreasonable to surmise that if service development pursues a path that insists upon only increasing super-specialisation of workers then this risks (albeit unwittingly) serving an agenda of social exclusion; it is difficult to envisage a time when there might really be enough highly trained specialists to fill vacant posts. However, more significant by far, the barefoot KeyWorker (or 'IMP') can deploy therapeutic modalities in settings where there would otherwise be none, and the integrated and multimodal nature of these interventions, that are delivered flexibly, largely contingent upon the needs of the here-and-now, offers hope for effectiveness in these hard-to-reach settings that has currently not been realised.

So, while KeyWorker described in this manual shares some of the features of the barefoot doctors of revolutionary China, the comparison is more descriptive analogy than fact.