This study examined the prevalence, willingness to report, and treatment preferences for suicidal ideation among state prison inmates. The Beck Scale for Suicide Ideation (BSS) and a novel questionnaire were completed by 67 inmate-patients. The BSS score was in the high range for 15% of general population (GP) and 40% of Intermediate Care Program (ICP) patients, with 19% of ICP inmates reporting a “moderate to strong” desire to commit suicide. A majority (64% GP, 86% ICP) had prior suicide attempt(s). Forty-two percent of GP and 31% of ICP inmate-patients were unlikely to tell mental health staff about suicidal thoughts. Family contact and talking with mental health staff were preferred interventions. ICP inmates preferred staff visits and observation in their own cells, but GP inmates did not. Only a small minority (14% GP, 21% ICP) favored transfer to a crisis observation cell, but the least desired option was talking to a corrections officer. While many inmate-patients reported experiencing suicidal thoughts, they preferred not to inform staff. Almost 80% did not favor the current primary intervention: the observation cell. Alternative or supplementary options should be considered. Copyright © 2013 John Wiley & Sons, Ltd.