River health worldwide has deteriorated throughout the past century due to human activity, jeopardising biodiversity, ecosystem services, and human health. Restoration efforts to curve this decline range from localised in-channel modifications to river basin-scale stakeholder engagement aimed to facilitate adaptive management. To address this challenge, it is necessary to view rivers as social-ecological systems which include a set of feedbacks between human systems and river ecosystems. It is then possible to use a ‘systems thinking’ approach to identify key leverage points to enable widespread improvements to river health. Donella Meadows' leverage points framework categorises interventions based on their potential in achieving transformative change and the feasibility of being able to take action. By applying this framework, we provide insight into how transformative change can be leveraged to support river restoration, with a focus on catchment-scale dynamics, specifically in the UK. Our analysis reveals a misalignment between active (i.e., in-situ restoration) and passive (i.e., governance and societal support) restoration due to governance, social design, and the underlying societal values. We propose two scenarios to leverage greater restoration efforts: (i) top-down governance changes to emphasise the societal value of natural ecosystems, and (ii) bottom-up initiatives to alter societal values around restoration and influence governance. The latter, by proximising the benefits of reinstating natural processes. However, the clash of simultaneously operating restoration and conservation paradigms was shown to hinder progress, highlighting the need for empirical research to further understand active and passive restoration dynamics. It is essential that these interactions are explored further to leverage effective restoration strategies to improve river health.