If outpatient therapy had not led to changes in his behavior, it may be needed that a higher level of care is explored. He must be willing to work on his issues as no therapy or medication would do this for him if he is resistant. If he is open to working on his issues, you may want to explore levels of care such as Residential Care or at least Intensive Outpatient Therapy. If he is ever in a crisis or aggressive, he would need immediate eval at the ER. The ER staff can then make the referral to a higher level of care. If he is not in crisis or aggressive, you would be able to get the names of these programs from his insurance and set up an evaluation for him to see if he meets the criteria. Along his treatment, some family therapy may be helpful so he does not feel a sense of alienation and is able to verbalize his anger and its causes.