You can lead the horse to water, but you can't make them drink.I think he has legit crippling depression. Like the medical condition where the chemicals in his brain are so fucked up that he can't function. Depression is kind of a meme cause so many people falsely claim it when they're a little sad or a little lazy or just wanna be a victim and get attention, but real brain chemical depression exists. Not absolving him of responsibility for his choices/actions or saying he didn't dig the hole he's in, but he's clearly actually mentally ill and not able to get himself out of it after years of going ever deeper into it. He doesn't even seem to do the most minor things to save himself. He needs a doctor and medication.
Spoony as I recall was diagnosed as having Bipolar II - which is a bit like normal Bipolar, but the high-part of the cycle never hits the crazy Manic level like in normal Bipolar. I remember him joking about it at the time when he was still vaguely capable of a joke between sad/wrestling tweets. I do recall him seeing doctors a bunch post CA-fallout and Scarlet. So it's not like he hasn't ever seen a professional. He has also spoken about trying therapy - but his twitter thread about it suggested he never had any intention to actually try it - so it was a waste of everyone's time.
But then - there's only so much a doctor can actually do for Depression. They can get you time off and give out anti-depressants, but a good doc will be cautious with resorting to those unless you convince them nothing else is working. They'll normally recommend CBT or other self-therapies that teach methods to identify when a depression/anxiety episode is incoming and how to try and counter or overcome it. The biggest step to curing depression is being able to say your tired of the numb nothingness or hopelessness you feel and asking for help. Which is difficult, but many people still manage it even when they hit massive lows.
But that can only happen when your willing to say "I deserve better" and are willing to look at what tends to set those episodes off. April likely stuck around because yeah, people who struggle with depression before getting help tend to need a bit of time and understanding. But it hit a point where she realised he didn't even want help to get better and just wanted to wallow in that misery.
Even if his folks or Miles showed up and forced him to the docs, it's all a waste till he says he wants to be better.