A comprehensive understanding of the mechanical behavior of backfill under compression is crucial for optimizing its design, improving stope stability and enhancing resource recovery. Laboratory testing and numerical simulation were conducted to study the mechanical properties and damage mechanism of cemented tailings backfill (CTB) with different cement-to-tailings (c/t) ratios under uniaxial compression. Laboratory testing was used to investigate the strength and deformation characteristics, macroscopic failure modes, and energy evolution patterns of CTB, while simulation with Particle Flow Code (PFC) was employed to explore the distribution of microcracks and mesoscopic damage mechanisms. A constitutive model accounting for the initial compaction stage was proposed, validated, and applied to practical engineering. The results show that as the c/t ratio decreases, the failure mode of CTB transforms from shear failure to combined tensile-shear failure, and tensile failure. Mesoscopically, a higher c/t ratio leads to more bond contacts, which increases the bearing capacity and consequently causes more cracks to damage CTB. From an energy standpoint, the damage mechanism of CTB is further analyzed and the development of energy is characterized by four stages. Moreover, to explore the failure mechanism of CTB, an innovative constitutive model was proposed and verified through experiments. The matching coefficients, based on the novel constitutive model, indicate that CTB with a c/t ratio of 1:6 is qualified for all current mining depths, and a c/t ratio of 1:10 is sufficient to depths below 300 m.