Rivers are under increasing strain to support their ecosystems and social systems while meeting demands placed upon them by humans and climate change. Environmental flows (e-flows) are a useful tool to help managers meet these demands. The slow pace of implementation in many parts of the world is perhaps, in part, caused by the difficulty of applying a concept entrenched in the hydrological field to river systems that are entangled with human communities. Despite this growing recognition, incorporating social elements into e-flows has been inconsistent. We examine how the concept of social-ecological systems (SES), a theory that social scientists have used for years to interpret rivers and other such systems where humans and nature are inexorably intertwined, can be useful for reframing the application of e-flows and addressing current implementation barriers. We compare SES and e-flows in terms of ontological background, strengths, weaknesses, and implementation approach to explore how elements of social-ecological systems thinking could help advance current approaches to e-flow development. We found e-flows were limited by their tendency to isolate outcomes away from other variables in assessment-driven processes. The emphasis within SES thinking to view systems holistically and consider causal loops and relevant scale could be useful in making e-flows relevant to entire river systems and the institutions that govern them, rather than for isolated subsystems. Additionally, we considered how the language used to describe e-flows can align with some ontological and cultural backgrounds better than others, increasing opportunities for stakeholder participation aligned with specific disciplines or cultures. With the persistent need for effective river management, SES thinking may be valuable when considering how e-flow design and implementation can better encapsulate the systems they are designed to preserve.