The primary goal of hybrid scenarios in tokamaks is to enable high performance operation with large plasma currents whilst avoiding MHD instabilities. However, if a local minimum in the safety factor is allowed to approach unity, the energy required to overcome stabilizing magnetic field line bending is very small, and as a consequence, large MHD structures can be created, with typically dominant m = n = 1 helical component. If there is no exact q = 1 rational surface the essential character of these modes can be modelled assuming ideal nested magnetic flux surfaces. The methods used to characterize these structures include linear and non-linear ideal MHD stability calculations which evaluate the departure from an axisymmetric plasma state, and also equilibrium calculations using a 3D equilibrium code. While these approaches agree favourably for simulations of ITER relevant hybrid regimes in this paper, the relevance of the ideal MHD model itself is tested through empirical examination of helical states in MAST and TCV. While long lived modes in MAST do not have island structures, some of the continuous mode oscillations exhibited in high elongation experiments in TCV indicate that resistivity may play a role in further weakening the ability of the tokamak core to remain axisymmetric. The simulations and experiments consistently highlight the need to control the safety factor in hybrid scenarios planned for future fusion grade tokamaks such as ITER.