At a time when Connecticut should be adding mental health services, the Institute of Living in Hartford is closing its nationally known Schizophrenia Rehabilitation Program.

The program's most effective treatment components are being reorganized into programs within the institute.

If the goal is to provide excellent mental health care to those who need it, shuttering the institute's signature schizophrenia rehab program would seem to be heading in the wrong direction. But the future of health care will involve many such compromises as hospitals look realistically at the huge challenges they face in next few years and try to make programs more financially viable.

The closure is linked to cutbacks announced last week by Hartford HealthCare, which includes five general hospitals and other facilities and employs 18,000 people statewide. It said it will eliminate 350 positions.

Medicare and Medicaid reimbursements "do not come close to covering expenses" of the schizophrenia program, says Dr. Harold I. Schwartz, chief of psychiatry at the Institute of Living and regional vice president of behavioral health at Hartford HealthCare.

It's an enormous flaw in public mental-health reimbursement practices. Said Dr. Schwartz, "Our response is to work as hard as we can to figure out a way to deliver the critical elements of the program more efficiently."

Easier said than done, of course, but the flaw should have been fixed long ago with realistic reimbursement rates. Inadequate reimbursements epitomize the discrimination and stigma that the mentally ill face on a daily basis.

Meanwhile, the institute has a post-cutback goal of serving the same number of patients seen by the rehab center now, with "core staff members" providing "core services" in the adult day program and the young adult day program. "You may not have all of the richness, but the critical services will be there," says Dr. Schwartz. He says he's confident the institute will continue to provide outstanding programming to individuals with schizophrenia.

It still sounds like less.

The institute's rehabilitation program has helped patients with schizophrenia reintegrate into the community. Says advocate Jan Van Tassel: "It's often the difference between just living and being stable. In fact, these are exactly the services that need to be expanded."

Amen.