The city consists of the population centres of Métabetchouan, on the shores of Lac Saint-Jean at the mouth of the small Couchepaganiche River, and Lac-à-la-Croix, a few kilometres to the east on Cross Lake.

Historically the territory of the indigenous Innu, the first European, Jesuit Jean de Quen, visited the place in 1647, followed by Charles Albanel in 1671, during the meeting of twenty Indian nations.

However, real colonization only began after the proclamation of Métabetchouan Township in 1857, and the first settlers arrived from the South Shore and Bagotville in 1861.

[4][5] The place was first called Saint-Jérôme, in honour of Jérôme Demers (1774-1853), vicar general of the Bishop of Quebec (1825-1853).

It was named after the adjacent lake where, according to popular thought, a cross was planted on its shores by François de Crespieul in the 17th century.