Sustainable urban water management (SUWM) requires an integrated, adaptive, coordinated and participatory approach. Current urban water policies are beginning to reflect this understanding yet the rhetoric is often not translated to implementation. Despite the ‘new’ philosophy, urban water management remains a complex and fragmented area relying on traditional, technical, linear management approaches. Despite widespread acknowledgement of the barriers to change, there has been little systematic review of what constitutes the scope of such barriers and how these should be addressed to advance SUWM. To better understand why implementation fails to occur beyond ad hoc project interventions, an extensive literature review of observed and studied barriers was conducted. Drawing on local, national and international literature from the field of integrated urban water management and other similar fields, 53 studies were assessed, resulting in a typology of 12 barrier types. The analysis revealed the barriers are largely socio-institutional rather than technical, reflecting issues related to community, resources, responsibility, knowledge, vision, commitment and coordination. Furthermore, the meta-analysis demonstrated a paucity of targeted strategies for overcoming the stated institutional barriers. Evaluation of the typology in relation to capacity building suggests that these systemic issues require a sophisticated programme of change that focuses on fostering social capital, inter-sectoral professional development, and inter-organisational coordination.