Sustainable flood risk management (SFRM) has become popular since the 1980s. Many governmental and non-governmental organisations have been keen on implementing the SFRM strategies by integrating social, ecological, and economic themes into their flood risk management (FRM) practices. However, the justifications for SFRM are still somewhat embryonic, and it is not yet clear whether this concept is influencing current policies in different countries. This paper reviews the past and current flood management experiences from flood defence to SFRM in four developed countries to highlight lessons for coastal megacities in development. The paper explores recent strategies such as “Making Space for Water”, Planning Policy Statement 25 (PPS25), and the National Planning Policy Framework (NPPF) in the UK and “Room for the River” in the Netherlands, which were implemented to mitigate flooding, integrate FRM with sustainability concepts, and deliver sound FRM practice for future generations. In this context, the United States has also established a National Flood Insurance Program (NFIP), and in a different approach, Japan has developed an advanced flood warning and evacuation contingency system to prepare for climatic extremes. These case studies give good lessons in achieving long-term SFRM to deliver sound flood management practices considering socio-economic and environmental concerns. Most developing coastal megacities especially in Asia are still heavily reliant on a traditional hard-engineering approach, which may not be enough to mitigate substantial risks due to human factors (e.g. large population, rapid socio-economic growth, subsidence from excessive groundwater extraction) and natural factors (e.g. climate change including sea-level rise and land subsidence). It is clear that different countries and cities have their interpretation of SFRM, but this paper explores how policymakers can adopt “mixed options” to move towards long-term thinking about sustainability with social, economic, and environmental ...