Background <p>National data suggest that the mental health of Australian workers has declined over recent years. Given that genetic contributors to mental health conditions generally remain stable in longitudinal observations, it is possible that social determinants, which are contextual, non-medical factors, contribute to this trend. This qualitative research investigated employee experiences of psychological injury, including social determinants as facilitators and barriers to recovery and return to work, and gathered need-based recommendations.</p> Methods <p>Between October and December 2023, 55 participants (<i>M</i>_age = 44&#xa0;yrs, 80% female) completed an online survey of demographic items and questions around injury and recovery experiences. Employees who were prescribed sick leave for at least two weeks due to a work-related psychological injury and managers who supervised at least one employee with a work-related psychological injury were eligible to participate. A subset of 12 participants also completed an in-depth online interview. Thematic analysis underpinned by a critical realist/contextualist lens was used to generate themes.</p> Results <p>Eleven themes described common experiences, facilitators, and barriers and were ordered along three meta-themes of injury causes, responses to injury, and recovery processes. Participant recommendations based on needs assessments centred around clear reporting systems for psychological injury, ongoing support and advocacy for employees, workplace accountability, and minimisation of requirements to access treatment, salary support, and sick leave.</p> Discussion <p>Detrimental work factors, negative disclosure experiences, and barriers to mental health care and return to work were described by employees who reported negative functional and mental health impacts, whereas managerial support and strength-based work modifications were protective.</p>