For more than a century, thousands of mentally disabled Americans were isolated from society, sometimes for life, by being confined to huge state institutions.

In at least one place, they still are.

Texas has more mentally disabled patients in institutions than any other state, and the federal government has concluded that the state's care system is stubbornly out of step with modern mental health practices.

Critics allege that Texas remains stuck in an era when the mentally disabled were hidden away in large, impersonal facilities far from relatives and communities.

For the third time in three years, the criticism has attracted the attention of the Justice Department, which on Tuesday accused Texas of violating residents' constitutional rights to proper care.

Investigators found that dozens of patients died in the last year from preventable conditions, and officials declared that the number of injuries was "disturbingly high."