This paper forms the foundation for the promotion of mental health with rural Mi’kmaq youth through a community based participatory research project. Western understandings of mental health and illness are compared and contrasted with Aboriginal understandings. Mainstream mental health services that accommodate cultural differences do not speak to the totality of Aboriginal understandings of mental health or to self-determination and self-reliance of Aboriginal peoples. The paper comprises three sections. Differences in the major understandings of mental health and illness are examined in the first section and common understandings associated with these concepts are addressed in the second section. Within the third section an analysis of three exemplar models of Aboriginal mental health and illness services is conducted. These models illustrate similarities and differences, and provide evidence of the effectiveness of health promotion that is inclusive of difference. The paper concludes that research to address Mi’kmaq youth mental health must be conducted with an awareness of how Western and Traditional systems of health and healing operate: in isolation of each other; in parallel directions; and in collaboration with each other. Aboriginal youth can benefit from the knowledge and wisdom of both understandings of mental health and illness.