Mental Health Matters Award Nomination Form

Every day, mental health and substance use treatment organizations, professionals, and individuals provide vital services to people in need and advocate for themselves. Macomb County Community Mental Health (MCCMH) is celebrating their selfless efforts, advocacy, and commitment to delivering care through the creation of its Mental Health Matters Awards. Beginning March 15, 2023, through May 1, 2023, MCCMH is accepting nominations in the five identified award categories.

All nominees must be involved with MCCMH within the last year. The selected nominees will be invited to attend the May 18, 2023, dinner event along with 2 guests to receive an award and be celebrated in communications throughout the community. Winners will be announced no later than May 18, 2023, on MCCMH’s website (www.mccmh.net).

To nominate a local champion, please use any of the below identified categories. Please ensure to provide a detailed narrative on why you are nominating the organization or individual.

If you have any questions, please email Communications@mccmh.net.

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* 1. Name of the individual or organization you are nominating.

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* 2. If applicable, what organization is the individual associated with?

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* 3. Email of the individual you are nominating. (Note: The individual's contact information is required so they can be reached if they are selected as the award recipient.)

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* 4. Phone number of the individual you are nominating. (Note: The individual's contact information is required for them to be contacted if they are selected as the award recipient.)

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* 5. Which of the below categories are you nominating the individual? (Note: If you would like to nominate an organization or individual for more than one category, please complete a second nomination form by returning to the original link.)

Self-Advocate Champion – Individual who is receiving or has received services from within the MCCMH system and advocated for themselves or others . Nominees must meet the following criteria:
· Impact: The individual must have a history of advocating and interacting with multiple individuals and/or organizations to reach their goals.
· Bravery: The individual illustrates their commitment to advocacy despite challenges that may arise.

Provider Champion – Mental Health or Substance Use provider within the MCCMH system who goes above and beyond in the provision of services. Nominees must meet the following criteria:
· Impact: The provider must have a history of successful provision of services and recent measurable accomplishments that demonstrate their positive impact on MCCMH persons served.
· Innovation: The provider must demonstrate innovation through creative efforts to reach out and provide services in the community.

Caregiver Champion – Individual who provides care to a MCCMH person served. Nominees must meet the following criteria:
· Impact: The individual must have a history of exceptional caregiving.
· Person Centered: The individual illustrates their commitment to provide person centered care demonstrated by their tireless efforts to help others meet the goals of recovery, community participation, self-sufficiency, and independence.

Community Partner Champion – Organization that partners with MCCMH to support and advocate for people served. Nominees must meet the following criteria:
· Impact: The individual or organization must have a history of partnership that help others meet the goals of recovery, community participation, self-sufficiency, and independence.
· Innovation: The individual or provider must demonstrate innovation through creative efforts to reach out and provide services in the community.

Advocate Champion – An organization or individual who advocates for those living with mental illness, developmental / intellectual disabilities, or substance use diagnosis. Nominees must meet the following criteria:
· Impact: Individual who has demonstrated exemplary efforts and results in advocating for others to meet their behavioral health needs.
· Bravery: The individual illustrates their commitment to person served advocacy despite challenges and any public perceptions.

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* 6. Please provide a detailed narrative with the reasons why the individual / organization is being nominated. Please provide specific and measurable information when possible.

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* 7. I would like to remain anonymous.

Yes

If no, please provide your name. If you would like to know if your nominee was selected, please also provide your email address.