Hartford HealthCare's plans to shutter the 20-year-old Schizophrenia Rehabilitation Program at The Institute of Living because of low rates of insurance reimbursements strikes at the heart of treatment for the severely psychiatrically ill in Connecticut.

Having a diagnosis of schizophrenia makes life difficult, to put it mildly. Hallucinated voices criticizing one's behavior, irrational, often paranoid beliefs that cause fear and make sufferers suspicious of the intentions of even their closest loved ones. This can make daily life with the disorder a Herculean struggle for the entire family.

Impairments in the ability to pay attention to what other people have to say, remember life events and recognize social cues only add to the misery. In fact, current epidemiological work suggests that 70 percent to 80 percent of individuals with a diagnosis of schizophrenia are unemployed at any one time. Only half of 1 percent of individuals diagnosed with schizophrenia who receive Social Security Insurance ever remove themselves from entitlements.

Individuals with schizophrenia represent a substantial proportion of the homeless population in the U.S. The World Health Organization lists schizophrenia as one of the top 10 leading causes of disability among adults worldwide. In the worst cases, in the absence of treatment, many of these individuals wind up in prisons due to erratic, socially unacceptable (but most often harmless) behavior related to their symptoms. Prisons are ill-equipped to treat them and they become highly vulnerable targets of other prisoners.

The disorder is typically lifelong and individuals with it do not improve without targeted treatment. So, programs designed to address the needs of this vulnerable population are desperately needed.

The Schizophrenia Rehabilitation Program, internationally recognized for its treatments, is one of the very few treatment centers in Connecticut that can address the needs of this patient population and the only program, to my knowledge, to offer such a rich array of integrated services with such proven results. Indeed, despite the dire statistics, we know that evidence-based treatments can improve outcomes in schizophrenia and that many people with the disorder can live rich and fulfilling lives, even with residual symptoms.

The record of the Schizophrenia Rehabilitation Program proved this fact over and over again. The expertise of the staff, coupled with the innovative and integrated evidence-based rehabilitative treatments that it offers, are all crucial for better outcomes in the disorder. This includes cognitive remediation for disruptions in concentration and other mental skills, social-skills training for persistent deficits in social interaction abilities and employment support for successful competitive work outcomes, coupled with careful medication management.

One of the reasons the Schizophrenia Rehabilitation Program has been so successful is that research shows these services work best when offered as a package. Stand-alone treatments simply are not enough for improving outcomes in a meaningful way.

I know the financial stresses upon health care institutions are intense, particularly with the rapid changes occurring in the way health care costs are paid. I respect the fact that Hartford HealthCare is trying to survive in an unforgiving financial climate. We need, however, to consider whether surviving financially at the expense of the needs of clients who are most vulnerable and most able to benefit is truly consistent with the mission of health care organizations.

Do we really want a two-tier medical system where those with the most disabling disorders, and not surprisingly the least means, get less than everyone else? Closing the Schizophrenia Rehabilitation Program is an irreparable loss of a profound magnitude for the clients of the program, the reputation of the hospital, and the broader community and state.

Matthew M. Kurtz is an associate professor of psychology and neuroscience and behavior, and chairman of the Program in Neuroscience and Behavior in the Department of Psychology at Wesleyan University, schizophrenia.research.wesleyan.edu.