This chapter explores both the harms caused by approaches that deny epistemic rights to Indigenous people and how considerations of Indigenous epistemologies can help “expand” evaluations of brain health interventions. A modified narrative review was conducted to explore the mechanisms by which considerations of Indigenous epistemologies can lead to a more comprehensive evaluation approach. The review is informed by theoretical ideas from realist evaluation and Hawaiian epistemology. The promise of Indigenous approaches, such as Hawaiian epistemology, are their proclivity to bring history and larger social, cultural, and environmental factors into explanations of assessments of individuals’ brain health and mental health. Key findings include that evaluation approaches sometimes perpetuate harm by dismissing communal experiential knowledge, normalizing social suffering from colonial legacies, and prioritizing deficit-based metrics. In contrast, Indigenous epistemologies emphasize holistic wellbeing encompassing physical, mental, spiritual, and environmental dimensions, as demonstrated through culturally grounded tools. The review identifies four themes: (i) Recognizing violations of rights and historical structural violence, and their implications for brain health; (ii) Cultural dimensions of screening; (iii) Cultural interventions “work”: empirical proof of cultural approaches working in neurological settings; and (iv) Holistic views of health: steps towards “making things right.” The implications of the findings of the review for a broader theory of change, learning, and building an ecology of evidence for brain health are described.