In Spencer, suicide attempt raises questions about faith-based treatment

SPENCER, Ia. —  Alex Jacobsen felt anxious and mentally exhausted. Sweat flushed his face.

The thin 26-year-old hadn’t slept well for days. He wanted to rest and get away from the handful of other participants in the faith-based treatment program.

Jacobsen tried to relax on a couch on the third floor of the Dream Center in downtown Spencer. But the feelings of agitation and hopelessness persisted. He got up and wandered into a hallway, where he spotted a box cutter sitting on a cart.

At first, Jacobsen drew the blade across his neck, careful not to break the skin. But then, he told The Des Moines Register during an interview last month, he began to press harder — slicing his neck and throat again and again.

Minutes later, a Dream Center pastor found Jacobsen lying on the floor of a nearby men's restroom. He pressed a towel to the young man's throat to slow the bleeding until paramedics arrived. They got there just in time: Five minutes more and he would have died, they said.

This is the story of a troubled and suicidal young man who agreed 10 days earlier, over his family's objections,  to abruptly stop taking the medications his doctors prescribed and skip an evaluation for outpatient treatment at University of Iowa Hospitals. At the urging of his pastors, he says, he would entrust his recovery to them and to God.

Faith-based drug treatment in Iowa goes unregulated

It also is a story about Iowa's scattershot mental health system, and whether those who offer faith-based treatment programs should be subject to state standards and oversight if they are enrolling people such as Jacobsen and others with mental illnesses.

But first you have to know Alex Jacobsen and those who tried to help him.

Troubled and tired of prescriptions

In early January, Jacobsen surprised his father, Dave, a prominent Spencer businessman and landlord, telling him he was joining a local, yearlong residential treatment program begun by two Assembly of God pastors he respected and considered friends.

It was no secret the younger Jacobsen wanted help. The University of Iowa graduate had tried a mix of prescription drugs, and a few he acquired illegally such as marijuana and Adderall, to rid himself of the depression, anxiety and uneasiness he felt — especially around others.

Those symptoms, along with fears of being a burden to his family, drove Jacobsen to attempt suicide a year earlier.

Jacobsen was scheduled in January for a new consultation at the University of Iowa Hospitals in Iowa City to see whether he was a candidate for outpatient treatment.

But he was also under pressure.

A physician’s assistant told him she thought he was using too much of the anxiety drug Klonopin, he says. He disagreed. But she was also concerned about his occasional pot use, so she insisted he needed to taper off over 10 days that month.

Jacobsen agreed. “I’ve always wanted it to be true that I didn’t need anything,” he said.

Pastor's solution: Closer bond with Jesus

The free discipleship program Jacobsen wanted to try offered to heal people of substance abuse, anger, depression and "the emotional residue left by mental, physical and sexual abuse” through prayer, Scripture memorization and building a closer relationship with God, according to its promotional materials.

One firm requirement for all participants: No mood-altering drugs.

Jacobsen says he had his doubts that the program would work. But he wanted to try trading in his antidepressant and antipsychotic medication for a regimen of Bible study, amino acids and GABA supplements to reduce stress.

He says his close friend of about a year and a half, the Rev. Kevin Grimes, had convinced him “medicine alone wasn’t going to be the answer to my problems.”

Grimes believed that placing Jacobsen in a safe environment, where he could get closer to God, could be life-changing.

“In my mind, Alex’s anxiety was environmental,” the pastor said. “I knew he was stressed out. But I also knew he was taking all kinds of meds.”

A dream for Spencer

Grimes and his wife, Kim, spent 13 years at the same Assembly of God church in Highland, Calif. As Grimes describes it, they decided simultaneously one day that it was time to leave.

“We didn’t really want to move (away from California) so much. Our family was there. Our kids were plugged in,” he says. “We just really felt the Lord was calling us to move.”

Grimes, 50, says he had a hard time finding a new job in California, so he sent his resume across the country. In time, he was tapped by church leaders at DaySpring Assembly of God in Spencer, a city of 11,100 in far northwest Iowa at the confluence of the Little Sioux and Ocheyedan rivers.

He told his new parishioners at the Pentecostal church he had a “heart for the lost.”

The first time the couple drove by an abandoned warehouse for sale on the city's main drag in 2008, Grimes says he nudged his wife and said, “That should be a Dream Center.”

Grimes envisioned a youth center, food pantry, clothing donation center and free legal clinic for area residents, modeled after a network of such programs that began in Los Angeles. He and the church established a nonprofit and set about making the dream a reality after the owner offered to donate the building in 2009.

The final piece, the discipleship program, launched first for troubled women in early 2015. The men’s dorm opened in December.

A confidence builds

Active on social media, Grimes took notice of Jacobsen on Facebook, where the younger man described a difficult breakup with a girlfriend.

Jacobsen, a sporadic parishioner at DaySpring, volunteered at the Spencer Dream Center and worked in its Terrazzo Coffeehouse after graduating from UI in 2012.

The two men became close. Jacobsen said he didn’t feel the anxiety around Grimes that he felt around others. He talked about his drug and alcohol use, and told the pastor stories of other friends’ and family members’ substance use.

In November 2014, Grimes drove Jacobsen to a faith-based treatment program called Teen Challenge in Colfax. The program, Grimes said, had worked successfully for his brother and others.

Almost immediately, though, Jacobsen felt out of place among others whose substance abuse issues were primarily alcohol and hard drugs. He gave up after six weeks.

“Kevin, do I need to be addicted to meth for 18 years for God to help me?” he remembers asking Grimes.

Before Easter 2015, Grimes enlisted Jacobsen to help with lights for a church program. After three rehearsals, Jacobsen texted the pastor to say he would have to find someone else.

Feeling hopeless and inadequate, Jacobsen pulled his car into a garage on one of his father’s properties. He sat there for about 10 minutes to 15 minutes as the garage filled with carbon monoxide, he says, then thought better of what he was doing and went home to tell family what he had done.

The scare resulted in a three-month stay in a mental health facility.

Messages of concern

Throughout 2015, Jacobsen and Grimes often talked and messaged through social media.

Jacobsen would compliment Grimes on his sermons, and Grimes would ask how things were going at home. They exchanged heart-shaped emojis and texted “I love you” to each other.

Early in January, Grimes took his wife on a vacation to Australia and Fiji to celebrate their 25th wedding anniversary. Knowing Jacobsen's fragile mental state, he asked the Rev. Nick Hanges to keep an eye on their young friend.

Hanges, a recovering addict and Teen Challenge graduate, had moved to Spencer the year before, from Midland, Texas, to run the Dream Center's discipleship program.

Hanges modeled the program around Teen Challenge, using its teachings and materials.

Jacobsen liked and respected Hanges. But he waited until Jan. 5 to tell his father he was joining the program.

Dave Jacobsen says he called Hanges and asked whether his son could hold off until after his scheduled appointment at UI Hospitals. He says he warned Hanges of the prescription drugs his son was taking and asked about the pastor's credentials.

Hanges filled in the elder Jacobsen on his background, reminded him that Alex was an adult and assured him his son was making the right choice. If medical help was needed, he said, they would get it.

That same day, Alex Jacobsen messaged Hanges to say he was worried he wouldn’t be able to simultaneously discontinue his medications, which included Klonopin, Cymbalta and Latuda. He also worried that he would have too much "alone time" in the program, which, he said, might heighten his anxiety.

“Don’t back out of this again, man,” Hanges messaged back. “You won’t have that much alone time, trust me. This is what you need to do and you know that. I will help you get off the medications.”

No drugs, no liability

The contract Jacobsen signed that day required participants to certify they had no medical conditions that would keep them from participating. Jacobsen said there were several female residents but only one other male living in the program, under the guidance of Hanges and his wife.

The agreement also released the Dream Center and its affiliates of “any liability whatsoever arising as a result of death, injury or illness.”

The rules mandated that those in the program “withdraw from any and all substance dependence voluntarily and without the use of medication.”

Hanges, who became certified online as a faith-based Christian counselor by the International Institute of Faith-Based Counseling in Texas, said the Dream Center prohibited the use of any mood-altering drugs that might potentially be abused. It was a policy he adopted from Teen Challenge, the program from which he and his wife graduated.

“They didn’t say you have to (stop taking prescriptions),” he said of Teen Challenge. “They just said you can’t be on them."

But when Jacobsen had enrolled in Teen Challenge in 2014, he was encouraged to taper off his prescribed medication under a doctor’s guidance, he and his parents say.

Entering the discipleship program, Jacobsen says, he knew he was expected to stop taking his medications cold turkey.

Days after entering the program, Jacobsen said, he told Hanges he wasn’t feeling right and told him he was suicidal. Hanges, he said, thought the feelings would pass.

“Maybe I didn’t explain it to him well enough,” Jacobsen said.

'Outside my mind'

On Jan. 15, just 10 days after Jacobsen entered the program, Hanges found him in a large pool of blood in a bathroom next to the men’s dorm.

Hanges pressed a towel firmly to Jacobsen’s neck with one hand and dialed 911 with the other. Jacobsen’s trachea was severed. He was taken by air ambulance to a Sioux Falls hospital.

Grimes returned from vacation while Jacobsen was hospitalized and recovering from his injuries.

The two messaged briefly.

“I’m just glad you’re OK,” the pastor wrote.

“I’m OK. Sad that it happened but I was outside my mind and emotionally numb,” Jacobsen said.

Lying in his hospital room several days later and still unable to talk, Jacobsen reflected on what happened, scratching notes on a piece of paper to his mother, Julie.

“Maybe now Grimes will see faith doesn’t heal everything,” he wrote.

Weeks later, he and his father say, they asked Grimes not to contact them again.

A change of thinking

Alex Jacobsen says now he believes his suicide attempt was prompted by the abrupt withdrawal from drugs he was taking.

Medical professionals who treated Jacobsen told the family he could have died from suddenly quitting benzodiazepines such as Klonopin, often used to treat seizures or panic disorders. Sweating, insomnia, anxiety, fatigue, psychosis and suicidal thoughts are other withdrawal symptoms, according to research from the Society for the Study of Addiction. Many of the same symptoms also can occur from stopping Cymbalta, a drug for depression,  and Latuda, the antipsychotic he was taking.

Looking back, Jacobsen also questions his relationship with Grimes. Some of the communications between the pastor, a father of two, and himself now seem odd, he says.

“I kind of feel like he was grooming me that whole time for some other reason than being my friend,” he said. For what, he says, he doesn’t know.

In response, Grimes says only: “We were friends. We joked around.”

But Jacobsen's suicide attempt underscored that his small, faith-based program is not equipped to treat mental illness, the pastor said.

“Alex was right. We didn’t know the depth of his issues,” he admits.

Grimes says he and his nonprofit board have since changed the program’s rules.

Now, a doctor will have to assure them that a potential participant has been off mood-altering medications for at least a year before joining the discipleship program.

Grimes says he believes Alex Jacobsen was easily influenced by others. He says he is saddened by Jacobsen’s suicide attempt and grateful that Hanges saved his life.

Dave Jacobsen holds Grimes and Hanges responsible for what happened to his son.

He wants to know how a program claiming to provide drug treatment could be exempt from an Iowa law that requires licensing of such facilities.

He questions how a faith-based treatment program can operate without clinical expertise.

“They do not have the medical or psychological training to do what they’re doing,” Dave Jacobsen said. “If the state doesn’t require some sort of oversight, this will happen to other families.”

Lee Rood's Reader's Watchdog column helps Iowans get answers and accountability from public officials, the justice system, businesses and nonprofits. Contact her at lrood@dmreg.com, 515-284-8549 on Twitter @leerood or at Facebook.com/readerswatchdog.

Coming Monday: Holes in Iowa's treatment safety net.

HOW TO GET HELP

In Iowa, free help can be found by calling Your Life Iowa at 1-855-581-8111 anytime, or, from the hours of 2 to 10 p.m., texting 1-855-895-TEXT (8398).

Or call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or visit suicidepreventionlifeline.org.